What's Wrong With the Self in Schizophrenia?

Source: Unsplash/Mattieu Stern

Physicians and researchers have long considered schizophrenia to be a fundamental chaos of the mind. That has resulted in public conflations of the disorder to be "multiple personality disorder" or a set of erratic and disjointed behaviors, all of which come to be called "schizophrenic."

Those stereotypes and mislabels stem from a kernel of truth: patients with schizophrenia experience a disturbed sense of self-hood. Empirical research on schizophrenia disorders has also attested to the claim that psychotic disorders are a form of self-distortion or otherwise a disorder of one’s “self-hood.”

Symptoms like thought projections, broadcasting, and delusions of control are among those that can occur when a patient might be exhibiting a “self disorder.”

The Ipseity-Disturbance Model (IDM)

There are different theories about why the self is distorted in patients with schizophrenia and how those distortions contribute to the confusing and vast array of symptoms present in people with the condition.

A new paper from earlier this year looked at one of the most common theories, called the ipseity-disturbance model (IDM), which is the best-known model of what researchers describe as the self disorder in schizophrenia. In that theory, a “minimal self” is the foundational basis for what a functioning person needs to have a healthy sense of personal narrative and social and personal relationships. The self is thought to have a foundational subjective experience that is crucial for maintaining a degree of sanity, and can include basic concerns like when and how to feed oneself, conduct good hygiene, and other basic procedures that involve protecting the body and one's personhood.

The model depends on three fluctuating traits that include: hyper-reflexivity (exaggerrated self-consciousness), disturbed “grip” or “hold” (loss of salience and stability in perceptual and cognitive field of awareness), and diminished self-presence (diminished intensity or vitality of subjective selfhood).

Hyperreflexity refers to the increased awareness of one’s bodily processes as “othering” experiences rather than interpreted as one’s own experiences. Processes like breathing or tactile sensations might be felt as if they're happening to someone else, not to the sense of self that is expected to be present in the body that is experiencing those things. As a result, the person might be unable to even perform basic movements like hand-waving because of the over-objectification of the act.

Disturbed grip or hold is another trait that refers to the loss of ability to determine what is real or unreal; the person’s sense of reality might be fading, and they might not feel like they live in a reality shared by everyone else.

The last trait, diminished self-presence, refers to a decreased sense of “I” processes. A patient might verbally say, “My I-feeling is diminished,” referring to the reduced capacity to subjectively be at the center of one’s narrative.

IDM is used not only as a diagnostic criterion but also as an argument for the idea that all symptoms, like hallucinations and delusions, stem from this disrupted sense of self. But, does this model adequately explain what goes on in the psychotic disorder? The researchers propose some revisions.

Is the Ipseity-Disturbance Model Adequate?

There are concerns and limitations to this model. Among them are the issues of replicability in empirical methods used to study the self. The Default Mode Network (DMN) is a foundational element of selfhood research. It is a network of regions within the brain that has been shown to be active during the engagement of personal narratives like excessive worrying or rumination. Aside from the DMN, IDM does not have as many neurobiological correlatives that would be able to explain IDM within a body-centered context.

IDM fails to account for different traits. One of those topics of negligence is of the seemingly paradoxical “co-existence or dynamic shifting” between grandiose perceptions and minimizing roles of selfhood. One can have delusions of grandeur while also feeling insignificant if someone were to socially falsify those claims.

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Another neglected topic is “increased grip or hold” on reality, which makes the individual more prone to beliefs and experiences that might seem mystical or other-worldly. Another area of concern is exaggerated or increased sense of self-presence, which may result in ontological paranoia.

Suggested Revisions of the Model

The researchers propose a few revisions to the IDM model, including a movement toward a spectrum-based model where diminished and exaggerated perceptions of self-presence are seen to be in constant flux, perhaps between, but even within, individuals during single events.

Historically, CBT-based philosophies have argued that schizophrenia is defined largely due to the patient’s inability to reason. These revisions to IDM would suggest it is less about reason and more about fundamental states of mind of varying degrees of perceived self-presence to serve as a foundational element that would later incur the psychotic symptoms.

Maintaining that view would help clinicians understand that the cognitive states of schizophrenia can be meaningful to many patients or people generally, which in turn might require more appreciation from clinicians and produce more empathy instead of attempting to change or rid patients of the realities they experience.