Self-Disorder in Schizophrenia
Most people when talking about schizophrenia are discussing the hallmark symptoms of schizophrenia: delusions, hallucinations, and disordered thinking. But have we been doing a disservice to those with the disorder by failing to talk about self-disorder? What is self-disorder and what part does it play in schizophrenia?
What is self-disorder?
We can’t discuss self-disorder without discussing the two types of self that are currently proposed to describe our experience:
Minimal Self
Referred to as the basic, core self
First person perspective; the “my” experience
Pre-reflective tactic level of selfhood
Foundational level
“Narrative” or Social Self
Refers to characteristics such as personality, social identity, habits, and personal history
“Self-esteem” and “self-image” refer to this level of selfhood
The sense of existing as a subject
Reflective, metacognitive processes, in which one’s self is an object of awareness
Self-disorder, also known ipseity-disturbance, is when there is a breakdown of the core minimal self. This presents as a minimizing of experiences as one’s own experiences.
An example of minimal self is that when observing an object, your focus is on the object, not on the experience of you perceiving that object. To know that you are looking at the object doesn’t require an act of reflection.
In schizophrenia, the minimal or core self is constantly being challenged and becomes unstable. The “mine”-ness of a situation can disappear or become unclear. It can become a challenge to know what thoughts and experiences are coming from yourself and which of those are coming from other people or the environment around you.
Examination of Anomalous Self-Experience (EASE)
The EASE is an interview with the patient who suffers from schizophrenia and the interview attempts to identify the extent of self-disorder experienced by the patient (out of psychosis). Out of psychosis is an important thing to remember because self-disorder is one of the few symptoms of schizophrenia that are experienced outside of psychosis. They are considered to be some of the most disabling despite rarely being talked about.
The EASE is divided into 5 sections:
Cognition and stream of consciousness
Self-awareness and presence
Bodily experiences
Demarcation/transitivism
Existential reorientation
Below are short explanations and examples from each section.
Cognition and stream of consciousness
These are disturbances in the flow of thoughts and experiences.
Silent Thought Echo: One’s thoughts become (involuntarily) repeated or somehow doubled
Thought Interference: Thoughts that are disconnected from the main line of thinking will automatically appear in the main line of thinking and interfere with it
Thought Block: One’s thoughts suddenly become blocked or a sudden emptiness appears
Ruminations/Obsessions: Persistent recurring thoughts or images
Ambivalence: The inability to decide between two or more options
Disturbance of Thought Initiative or Thought Intentionality: An observable lack of goal structure and planning
Disorder of Short Term Memory: Diminished capacity to keep things in mind for more than a few minutes
Disturbance in Experience of Time: A change in the experience of time as it flows or a disturbance in recognizing past from the future
Self-Awareness and Presence
This encompasses dissociative experiences, a tendency towards intense self-reflection, and a perplexity with the self and the world.
Diminished Sense of Basic Self: A persistent lack of inner core or identity; feelings of being nonexistent or profoundly different from other people
Distorted First-Person Perspective: An experience of distance between experience and self; observing one’s own mental thoughts as if they are not their own; also can increase in intensity to split self
Diminished Presence: The experience of not being fully present in the world
Derealization: A change in the experience of the environment, the environment feels strange and foreign
Hyperreflectivity: Intense reflection on one’s self or environment; excessive monitoring of inner self and experience
I-Split: Not experiencing life as one person, being divided
Loss of Common Sense: Inability to grasp the meaning of every day events or situations; not understand human conduct
Identity Confusion: The feeling of being someone else
Ontological Anxiety: The feeling of being exposed or threatened at all times; constantly in a state of self-preservation than self-reflection
Bodily Experiences
This is a disturbance in how the body is experienced.
Somatic Depersonalization: Experiencing some parts of the body as strange or separated
Psychophysical Misfit and Psychophysical Split: Experiencing a feeling that the mind and body do not belong together
Cenesthetic Experiences: Unusual sensations of pain in areas of the body; sensations of abnormal heaviness; feelings of being electrified
Demarcation/Transitivism
This encompasses disturbances in ego boundaries.
Confusion with the Other: Experiences of being mixed up with another person, losing sense of who’s thoughts or feelings originated from whom
Threatening Bodily Contact: Experiencing bodily contact as threatening to ones autonomy
Transitivistic Phenomena: Heightened perception and insufficient barriers against sensory stimuli
Existential Reorientation
This shows changes in how the world is experienced or reflected on due to the disorder.
Solipsistic-Like Experiences: Experiences themselves as being unique from others or having superpowers in some way
“As If” Feeling That World is Not Real: Experiences the world as not real, illusory, or deceptive
Existential or Intellectual Change: Unusual preoccupation with existential or religious themes; mystical experience, psychology, reincarnation, struggle between good and evil, meaning of existence, and universal peace
Solipsistic Grandiosity: Seeing oneself as superior over others
Examination of Anomalous World Experience (EAWE)
The EAWE is an add-on interview to the EASE but instead of focusing on the self, it focuses on the patients experiences with the external world. Some of these areas or experiences can overlap with self-experience.
The EAWE is divided into six sections:
Space and objects
Time and events
Other persons
Language
Atmosphere
Existential orientation
Below are short explanations and examples from each section.
Space and Objects
This section explains the experiences of space, physical objects, or sensory input.
Abnormal Intensity or Persistence of Visual Perceptions: Colors, light, or images are viewed as more or less intense than usual or failing to fade into the background
Blindness or Partial Blindness: Experience of the vision being blurred or unclear
Disturbances Involving Veridicality (Accuracy) of Visual Perceptions: Mis-seeing objects or seeing objects that are clearly not there
Object Fragmentation: It is impossible to see an object as a whole, instead seeing the whole as a bunch of fragments
Visual Hallucinations: Experience of visual sensations or perceptions that have no basis in reality
Distorted Experiences of Space: Experience of overall structure of space is distorted or changed in some way
Loss of Topographical Orientation: Experiencing a familiar place but feeling completely lost or disoriented
Loss of Boundaries with The Physical World: Being unable to determine where the body ends and the outside world begins
Time and Events
This section explains the various ways that time, events, or actions can be experienced.
Time or Movement Change Speed: Distortion of the in-the-moment experience of time; time slows down or speeds up and is unrelated to activity levels (being bored or excited)
Discrepancy Between Internal and External Time: Internal time is running at a different speed than what the outside work is running at
Perpetual Anticipation: The feeling that something very important is always about to happen; stuck in a state of suspense
Disturbed Awareness of the Expected Future: The imagined future is experienced as highly threatening
Premonitions: Describes knowing something is going to happen before it happens
Disturbed Experience of Memories from the Past: The experience of the past is changed in some way; slowed up, sped up, disappeared, or intrusive
Other Persons
This section focuses on the experience with other persons, social interaction, and ego boundaries.
Loss of Social Common Sense: Lacking understand of other people’s behavior or social encounters
Bodily/Proprioceptive Loss of Attunement: Largely physical sense of being out of sync or awkward with other people
Alienated/Intellectual Strategies for Understanding Others: Relies on detached observation of others or creates rule-based methods for understanding and responding to others
Pervasive Mistrust of Others: General sense that others are untrustworthy
Interference by Voices: Unable to participate in normal conversation due to experiencing voices that are distracting or disorganizing
Pathological Openness: Feeling that others can read your thoughts; the soul is exposed to others
Merging or Fluid Psychological Boundaries: Feeling the mind being mixed up with or invaded, as if experiencing the thoughts, feelings, and experiences of others; confusion of who thoughts originated from
Uncertain Personal Identity/Attitudes: Confusion about identity and attitude or preferences when in the presence of other people
Difficulties with Gaze: Feelings of discomfort or difficulty with maintaining eye contact; either feel personal gaze is intrusive to others or others gaze is intrusive to self
Active Withdrawal: Experiencing the need to withdraw from others
Language
This section focuses on the experience of language; the subjective experience of words and meaning; trouble with abstract or concrete.
Basic Disruptions of Standard Verbal Comprehension: Difficulty understanding speech or written language; reading or listening to others
Difficulty Understanding Emotional/Expressive Aspects of Speech: Difficulty recognizing emotional intonations in others speech
Words Seem Arbitrary/Absurd: Being abnormally aware of arbitrariness of words, to the extent of being unwilling or unable to accept standard usage or understand the intended meaning of the communication
Derailment: A tendency to lose track of the initial or overall goal of a statement when speaking or writing; lacking much sense of where the statement is going
Echolalia: A tendency to echo the speech of others
Anomalous Experience of the Abstract and the Concrete: Difficulty accepting or understanding abstract or general concepts; heightened focus on what is abstract or concrete
Alienation of Self-Description: Experiencing a profound sense of disconnect when describing self or experiences; difficulty with identifying with the self
Atmosphere
This section focuses on anomalies in the experience of the external world.
Derealization of the World: Everything in the environment feels strange; pervasive change in the feeling of the world
Inanimate Things Seem Alive or Intentional: Things that are nonliving feel alive somehow
Heightened Intensity/Hyperrealization: General increase in the intensity of the world; more demanding of attention
Deja Vu Experiences: An abnormal sense of familiarity with things not previously experienced
Jamais Vu Experiences: Perceiving something as familiar when there were no prior experience of it
Perplexity: Disturbing sense of being confused by reality
Unreal Interferes: Ability to function in everyday reality is disrupted by distraction by imaginary or delusional world
Actions or Events Seem Controlled by External Force or Will: Experienced as events somehow under the control of an external force or being
All-Inclusive Self-Consciousness/Ontological “Paranoia”: Pervasive sense of being watched
Double Bookkeeping: Awareness of two or more realities but can distinguish between what is real and other domains
Grandiose Significance: Believes that something signifies superior importance; chosen one, divine, or being favored
Existential Orientation
This section consists of attitudes or interpretations about relationship to the world.
Feeling of Being Special or Superior: Typically possessing superior knowledge or insight and/or having a special duty or role in the world or universe
Messianic Duty: Feeling a sense of extraordinary duty toward others
Adherence to Abstract, Intellectualistic, and/or Autonomous Rules: Feeling compelled to follow a strict set of rules **that emphasize rationality, an intellectual attitude, abstract or idealistic principles, or a compulsive urge to follow idiosyncratic “rules” or “laws”
Existential or Intellectual Change: New or unusual preoccupation with existential, philosophical, or religious themes
Decentering of the Self Relative to the Universe: Doubting own reality or that of the world
The Result of Self-Disorder
Those who experience self-disorder often times become hyper-reflective and can spend hours in a state of abnormal and intense self-reflection. This self-reflection is an attempt to gain awareness into their experiences with the world and what it means.
Self-disorder can also be an exhaustive experience as it requires those who experience it to double bookkeep - essentially keeping track of two worlds at one time, the normal everyday world experience and the world that contains the experiences of self-disorder. Keeping these two worlds separate is necessary for remaining “normal” appearing and not letting illness take over their lives.
Sometimes, however, these experiences are too difficult to keep separate and a person may experience some difficulty with interacting with the world and those around him. They may appear irrational or bizarre, experiencing the world, others, and themselves in a way that most others don’t understand.
Conclusion
Schizophrenia affects about 0.45% of adults. It is not a common disorder but it is one of the most misunderstood and stigmatized.
Becoming knowledgable about the disorder and the experiences of those with schizophrenia may help you understand and sympathize with those you know or observe who may be suffering from schizophrenia.
Please share your own experiences and knowledge about self-disorder in schizophrenia below.
To learn more about the experiences of those with schizophrenia, check out my other blog post 10 Things I Experience as Someone with a Schizophrenia Spectrum Disorder.
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