Self-disorders: A cause of poor insight in schizophrenia?

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Thanks. I didn't seem to have some of the worst of that solipsistic thinking. I know that other people have minds, I know that stuff that leaves my field of vision still exists, and I know that if I die the world continues. Of course, these people are looking more at what you feel things as, rather than what you know. So do I feel ever *as if* one of those things is true? Nothing comes to mind. Nevertheless, one sentence seemed to have a ring of truth to it, but in a way that I can't recall right now. It reminds me of something my dad told me:



^ This is where it's talking about how interacting with the world will erode solipsistic feelings, but the person here interacts very little with the world and is very passive, strengthening those solipsistic feelings.

Now, there is one other aspect of solipsism I'm aware of called solipsistic grandiosity, mentioned in the OP article, where you act and/or talk as if you have great insight into the world while everyone else is a moron who is only interested in superficial things. I think I had that during my psychotic episode at age 14, when I was thinking I had insight, and that was how I knew all the stuff I knew (the delusions), and thinking that nobody else would understand or even be capable of such insight; I knew that if I told somebody, they'd just think I was crazy and lock me up, which would be tragic to happen to somebody of such great insight, kinda like what usually happens on horror movies when the hero sees the ghost, tries to report it, and ends up having everyone doubt their sanity.

Have I had solipsistic grandiosity at other times, though? I'm not sure. Nothing specific comes to mind. I know that when it comes to math problems that others and I are solving, sometimes I feel like I have a much deeper understanding of the problem than others, and think that other people are only looking at it superficially without much deep understanding, and so I come in and kinda boss people around. I'm not sure how much of that is based on reality, however.

EDIT: Let me get back to you on the feelings I have about my old delusions. BTW, by feelings do you mean how the delusions felt, if I kept those, or regarding how I considered the delusions more in thought?

I can't seem to access that essay anymore.

Another thing is that I sometimes weird myself out with existential-type questions. Like for example, I would ask myself, Why am I in this body, with these traits, and with this mind? I always weird myself out when I get deep into this question.

A bit both, but more the last one.



I can still access the essay, so maybe try again?
I asked myself also a lot of questions about religion, but I would still consider myself as agnostic. It's complicated to explain, but it's like sometimes I totally get into religions and think about them, but deep down I'm still agnostic and so those situations just pass by. But it led to the fact that I've several books on all kind of different religions.
I also sometimes ask myself if just those things are real who I can see? But again, it's not a serious thought, it's more a question that pops up in my head and I'll think about it for a moment, but that's mainly it.
My paranoid thoughts are more serious.
Actually I never suffered from my delusion like thoughts, even when they where more extreme. Sometimes I even like to think about all that existentail stuff, but paranoid thoughts is just terrible to have.

But to come back to the structured interviews for a moment, if a psychiatrist would ask me if I hear or see things that aren't there? I would answer "no", eventhough I sometimes missinterpreted a shadow or sound, but I was usually aware of that. But I asked myself that question over and over, that how do I know those sympoms are "abnorm"? I mean many ppl belive in some kind of high spirit, missinterpret a shadow in the dark and so on. That's the thing with preschizophrenic symptoms. I guess upto a certain point you consider them as "normal", or even don't think about them sitting in front of a psychiatrist. So they would have to dig deeper, but they usually don't do that.

Well, I remember fantasizing over eschatological, video game, and Y2K themes in the few months leading up to the psychotic break. When we went on vacation to the beach, I remember spending lots of time wandering around, with a sense of anticipation, like something big was about to happen. It seemed everybody was lining up like NPCs in a video game. I saw a meteor and thought that was my sign and it was like I was told about my delusions. I thought the delusions were very important and that they meant I had great insight. When I was in the hospital at one point I felt a sense of disappointment as the delusions seemed to lose their importance, resulting in me not being delusional anymore.

When I look back I still think of that sense of importance that it had and that sense of anticipation. I know, too, that the delusions were not true.

I was looking at a catalogue of self-disorders here:

http://www.nordlandssykehuset.no/getfil ... r/EASE.pdf

A lot of these seem to have a ring of truth to them, but I would probably want to have an actual semi-structured interview to determine if I have certain self-disorders or not; of course, I probably won't get it. Nevertheless, there are a couple of self-disorders I could recognize almost immediately: 1.8 "Spatialization of experience" and 2.2.3 "Spatialization of the self."

Ever since around the time I turned 6, I noticed that my thoughts seem to come to me just above and behind my eyes, in the front portion of the cranium. I was located at the back of the cranium and I would look out at the world through the cranium and up into the space where my thoughts would appear.

From that link, I've this very extreme:

1.6 Ruminations – Obsessions (C.1.2)
(Usually) disturbing persistence or recurring of certain
contents of consciousness (e.g. thoughts, imaginations,
images): these contents may be associated with any past
event. It may have the form of meticulous recapitulation
of remembered events, or conversations of the day.

propably with that subtype:

Subtype 2
Secondary ruminations (perplexity-related or self-referring):
the obsessive-like states appear as a consequence
of a loss of natural evidence, disturbed basic sense of the
self or hyperrefl ectivity or they appear to be caused by
more primary paranoid phenomena (e.g. suspiciousness,
self-reference) or a depressive state.

Yeah, I'm pretty sure I meet subtype 2, as well. I also think I meet subtype 4, also:

Pseudo-obsessions: Obsession-like phenomena, which appear more as ego-syntonic (hence there is none or only occasional resistance), frequently with pictorial imaginative character and with a content that is directly aggressive, sexually perverse, or otherwise bizarre. May be anxiety-provoking.

Subtype 2 references the following item:

2.12 Loss of Common Sense/Perplexity/Lack of Natural Evidence

It is a loss or a lack of automatic, prereflective grasp of the meaning of everyday events, situations, people, and objects.

There are different domains in which this feature may manifest itself. The patient may be unable to grasp signification of everyday matters and situations (e.g. he may wonder about colors of traffic lights), may not understand the (tacit) rules of human conduct or interactions, or may become excessively intrigued or preoccupied by semantic issues. The naturalness of the world and of other people is lacking, and that usually leads to a certain hyperreflectivity. This symptom should not be rated if the major change comprises a persecutory paranoid threatening coloring of the world ('Wahnstimmung'). The reaction of the patient is of perplexity, curiosity, amazement, and attempts to understand (through reflecting) or to cope. Morbid rationalism and geometrism are sufficient but not necessary to rate this symptom.

Explanation of the Terms

Morbid Rationalism. Refers to a general attitude of the patient, who considers human moves, affairs, and actions as being guided by specific rules, rigid principles and schemas: 'A father buys a coffin to his dying daughter as a birthday present, because the coffin is something she is going to need' [Parnas and Bovet, 1991].

Geometrism. Preoccupation with spatial arrangements in the world, symmetry, mathematical or numerical aspects of the world; corresponds to certain lifeless rigid obsessionality.

This seems to be at the core of the so-called schizophrenic autism, as shown here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489853/

It also seems like it can be part of ASD.

I've to read more carefully about the link you posted above again. i've some trouble understanding everything. I'm not that familiar with schizophrenic terminologies used in english.

ASD and the schizophrenic spectrum is overlapping to some degree what explains why autistic ppl are not getting dx so fast. It even stands in the diagnostic criteria for schizophrenia that you have to consider certain aspects when the person is ASD. This is also considered with schizotypal PD and ASD. Schizotypal PD is underdiagnosed anyway in my opinion.
A psychiatrist who also researches in autism once said in a conference about ASD, that autistics show symptoms that usually are just seen in ppl with BPD (meltdown, extreme emotional states etc.) and also in schizophrenia (overload, starring in another direction, flat affect, etc.) and this leads to many missdx.

Last edited by Raziel on 25 Dec 2013, 2:36 pm, edited 2 times in total.

Raziel,

I had some trouble at first, as well. If you're still having trouble, what part are you having trouble with?

Numerous studies, such as this one, show that self-disorders tend to aggregate in schizophrenia spectrum disorders, and do not occur to the same extent in psychotic bipolar disorder and non-schizophrenia spectrum psychoses:

http://www.ncbi.nlm.nih.gov/pubmed/22759943

^ This study shows that the rate of self-disorders can distinguish schizophrenia spectrum disorders from other psychoses, including psychotic bipolar disorder.

What I've never seen, however, is a study that looks at self-disorders in autism spectrum disorder. I wonder if there is any sort of aggregation of self-disorders in ASD as well?

I was looking at this:

http://foundationsoftheself.squarespace ... ia2013.pdf

What seem to separate schizophrenia from depersonalization disorder, introspectionism, and mood disorders are self/other and self/world confusion along with displacement or erosion of first-person perspective.

There is a case of ASD with self/other confusion:

http://www.autism.org.uk/living-with-au ... tines.aspx

Also "erosion of first-person perspective" seems to refer to a kind of sensory issue in which things in your environment stop "building up" for you, meaning things look more fragmented. It seems this occurs in ASD as well.

Could you explain it a bit more please?

btw: I really like your new avatare

Thanks.

Depersonalization disorder is a dissociative disorder where you feel cut off from yourself and/or your environment. Introspectionism is where you choose to watch and think about every little thing you do. Mood disorders, of course, are major depression and bipolar disorder, along with the other mood disorders. Self/other confusion is where you have difficulty distinguishing your thoughts, feelings, and actions from those of other people. Self/world confusion refers to a confusion of who or what is moving when you move or when something or somebody else moves. Displacement of first-person perspective is similar to self/other confusion. Erosion of first-person perspective is less clear, but seems to refer to the environment and your thoughts and feelings not "building up" for you, becoming fragmented and losing meaning.

These are the EASE items I'm fairly sure I match now or have matched during my lifetime:

1.2 Gedankenenteignung
1.4.1 Thought block
1.6.2 Secondary ruminations
1.6.4 Pseudo-obsessions
1.7.1 Gedankenlautwerden, internal
1.7.2 Gedankenlautwerden, equivalents
1.8 Spatialization of experience
1.12.1 Captivation of attention by a detail in the perceptual field
1.14.2 Disturbance in the existential time
1.16 Discordance between intended expression and the expressed

2.1.1&2 Diminished sense of basic self, childhood onset with apparent worsening at puberty
2.2.1 Diminished sense of mineness
2.2.3 Spatialization of the self
2.4.2&3 Diminished presence with or without change in perception
2.5.1 Fluid derealization
2.5.2 Intrusive derealization
2.6 Hyperreflectivity
2.9 Identity confusion
2.11.2 A feeling as if being of the opposite sex
2.12 Loss of common sense/perplexity/lack of natural evidence
2.13.1 Panic attacks
2.13.4 Social anxiety
2.13.6 Paranoid anxiety
2.14 Ontological anxiety

3.2.1 Always looking in mirror without noticing change
3.2.2 Looking in mirror and noticing change
3.3 Somatic depersonalization
3.6 Spatialization of bodily experiences
3.7 Cenesthetic experiences
3.8.3 Motor blocking
3.8.4 Sense of motor paresis
3.8.5 Desautomation of movement

4.4 Beeinflussungsstimmung
4.5 Other transitivistic phenomena

5.2 Feeling of centrality
5.4 "As if" feelings of extraordinary creative power,...
5.5 "As if" feeling that the experienced world is not truly real,...
5.6 Magical ideas
5.7 Existential or intellectual change
5.8 Solipsistic grandiosity

That's a lot of items! It would be interestinng to be able to explore this with an actual psychiatrist trained in phenomenology! I wonder which items I listed are wrong for me and which ones I may have missed that are right for me!

If anyone has questions about why I think I may match a certain item, then please ask.

I've at the moment
1.1 Thought Interference (see "thought block, subtype 3")
1.4 Thought Block, propably with that subtype:

Subtype 3
Fading combined with simultaneous or successive
thought interference (score 1.1 as well): old and new
thoughts exist side by side, while the new one becomes
more prominent (more centered), the old one slowly recedes
into oblivion. The old thought gradually and sometimes
irregularly dies away (loss of its position in the focus
of consciousness = fading) and, simultaneously, there is
an intrusion and persistence of the new thought, increasingly
coming into the focus. Due to the interference of new
thoughts, there is no feeling of emptiness of thoughts.

1.6 Ruminations – Obsessions (could also be partly related to other factors)
1.9 Ambivalence (a bit, but I'm not sure if this is related to the schizophrenia spectrum or to other factors)
1.10 Inability to Discriminate Modalities of Intentionality (it's not an inability though, but I need a moment to distinguish)
1.13 Disorder of Short-Term Memory (but that's related to "thought block" again)
2.12 Loss of Common Sense/Perplexity/Lack of Natural Evidence
2.13 Anxiety Subtype 3 Phobic anxiety and Subtype 6 Paranoid anxiety (but those two influence each other)
2.15 Diminished Transparency of Consciousness
2.18 Diminished Vitality (could also be part of depression, connected to 2.15)
5.1 Primary Self-Reference Phenomena

but it's seems to get more severe though. I've to see my psychiatrist at the beginning of the new year. I guess it's comming partly from the Bupropion that he subscribed a while ago because of my ADD symptoms. That's also why I don't answer that much at the moment as I would like too, but I read all the posts in here and find this topic very interesting.