Phenomenology and neurobiology of self disorder in schizophrenia: Secondary factors.

Schizophrenia involves a core disturbance in the sense of self (disturbed ipseity), which can be traced to a primary disruption in how the brain integrates perceptions from different senses (perceptual dys-integration). This article describes secondary phenomenological alterations that arise either as downstream consequences of that primary disruption or as defensive compensations. These include heightened self-consciousness (hyperreflexivity), a diminished sense of self-presence, and a weakened grip on one's field of awareness. These secondary experiences vary greatly between individuals and over time, and they become more pronounced in adolescence due to developing prefrontal lobe capacities. This variability may explain much of the clinical diversity in schizophrenia while still pointing to a common underlying disturbance.

Study at a glance

Abstract

Schizophrenia is a diverse and varying syndrome that defies most attempts at classification and pathogenetic explanation. This is the second of two articles offering a comprehensive model meant to integrate an understanding of schizophrenia-related forms of subjectivity, especially anomalous core-self experience (disturbed ipseity), with neurocognitive and neurodevelopmental findings. Previously we discussed the primary or foundational role of disturbed intermodal perceptional integration ("perceptual dys-integration"). Here we discuss phenomenological alterations that can be considered secondary in a pathogenetic sense--whether as consequential products downstream from a more originary disruption, or as defensive reactions involving quasi-intentional or even volitional compensations to the more primary disruptions. These include secondary forms of: 1, hyperreflexivity, 2, diminished self-presence (self-affection), and 3. disturbed "rip" or "hold" on the cognitive/perceptual field of awareness. We consider complementary relations between these secondary abnormal experiences while also considering their temporal relationships and pathogenetic intertwining with the more primary phenomenological alterations discussed previously, all in relation to the neurodevelopmental model. The secondary phenomena can be understood as highly variable factors involving overall orientations or attitudes toward experience; they have some affinities with experiences of meditation, introspectionism, and depersonalization defense. Also, they seem likely to become more pronounced during adolescence as a result of new cognitive capacities related to development of the prefrontal lobes, especially attention allocation, executive functions, abstraction, and meta-awareness. Heterogeneity in these secondary alterations might help explain much of the clinical diversity in schizophrenia, both between patients and within individual patients over time--without however losing sight of key underlying commonalities.