disorders of self.pptx

PRESENTED BY :
Sakshi Maheshwari
M.phil Clinical Psychology(2021-23)
G.M.A.
⋆ DISORDERS
⋆ OF
⋆ SELF

INTRODUCTION
⋆ Self is a fundamental part of every human being ,a symbolic construct
which reflects our consciousness of our own identity
⋆ In any observation , an observer and an observed object are required. A
thing what observes that thing cannot be the same
⋆ But ,self takes an exception here ,for being its basic nature to be
experienced as either subject or object
⋆ Although most of the time we do not think so deeply and our self
awareness varies depending on both situation and personality

⋆ Self awareness is a psychological state in which people are aware of their traits ,
feelings and behavior. In other words ,it can also be described as the realization of
oneslef as individual entity.
⋆ According to Scarfetter ,one’s awareness is a special feature of distinguishing self
from other observing objects and to it is added the 5th character , VITALITY OF
SELF(knowing that I exist)
⋆ Ramachandran and Blakeslee call vitality as self reflection
⋆ Bahnson describes changes in self development starting from soma family,role
play in late childhood body image of adolescence social roles
INTRODUCTION

biolog
ical
social
Self
aware
ness

SELF AWARENESS PERSPECTIVE
• Lots are our experiences with a lot of time in life but
only one is ‘I’ ,who feels the past, present, future
continuity
• Diverse are our sensory experiences ,memories ,beliefs
,thoughts ,but each of us experience ourselves as one single
person as a unity
Unity or coherence of
self
• We feel ,’we’ begins with our bodies
Sense of embodiment or
ownership
• ‘we’ are in-charge of our own actions and destinies.
We have a free will which formulates our ‘to be done’
Sense of agency
• Most elusive of all ,the self ,almost by its very nature
,is capable of reflection of being aware of itself
Self-reflection

BIOLOGICAL PERSPECTIVE
embodied
• The self anchored within a single body ,similar to body image
passionate
• Emotional aspect of self-mediated by limbic system and amygdala
executive
• The “free will” allowing to make a choice and give motor commands attributed to anterior
cingulate gyrus
mnemonic
• Organizing yourselves on long strings of personal recollections and memories present in memory
circuits
unified
• Imposing coherence on consciousness, filling in and confabulation by brain process associated with
limbic and parts of cingulate gyrus
vigilant
• Intralaminar and thalamic nuclei driven by pedunculo-pontine nucleus processes the vigilance
conceptual
• Conceptualizes other abstract concepts like ‘love’,’happiness’,’mind’

SOCIAL PERSEPCTIVE
MICHAEL
LEWIS
(1990)
existential categorical
CARL
ROGERS
Self
image
Self
esteem
Ideal
self

//
Disorders of
awareness of being
and activity
Disorders of
immediate awareness
of self unity
Disorders of continuity
of identity of self
Disorders of boundary
of self

DISTURBANCES OF AWARENESS OF SELF ACTIVITY
⋆ All events brought into consciousness are associated with a
sense of personal possession . This ‘I” quality has been
called personalisation(Jaspers ,1997) .
⋆ There are 2 aspects to sense of self activity :
 sense of existence (disorders of being or ego vitality)
 Awareness of performance of one’s actions (disorders of
activity)

Disturbances of being or ego vitality
⋆ “Do I exist?” is never a question a person generally asks. It is by virtue of
assumption , we unquestionably are sure of our existence . The
existence of reality is accepted because of presence of self .
⋆ Self awareness is present in every psychic event . When we say “I think”
it accompanies all perceptions ,ideas ,thoughts .
⋆ This quality of “Iness” may be disturbed in various psychological
disorders . If this psychic manifestation occurs with awareness of this not
being mine ,of being alien ,automatic ,independent ,arriving from
elsewhere , the phenomenon is called Depersonalisation.

⋆ DEPERSONALIZATION (term used by Heymans in 1904 )
⋆ A change in awareness of one’s own activity occurs when the
patient feels that they are no longer their normal natural self .
⋆ Often this is associated with feeling of unreality , so that the
environment is experienced as flat ,dull and unreal .This aspect
of the symptom is known as DEREALISATION(term used by
Mapother in 1935) .
⋆ The feeling of unreality is core of this symptom and it is always
to a greater or lesser extent ,an unpleasant experience which
distinguishes it from ecstatic states

⋆ Depersonalisation and derealisation go together because the self and the non self
together form the experience of one continous whole
⋆ Normal sensory experiences of one’s body , ability to imagine and remember is
ceased leading to a inhibited feeling and feeling of one’s behaviour becoming
automatic
⋆ Patient may describe himself like a puppet : hollow , detached and strange ,on the
outside , uninvolved with life ; himself like a ghost –not solid ,a stranger to himself .
⋆ When patient first experiences the symptom they are likely to find it very frightening
and often think it is as sign that they are going mad .

⋆ Many patients also state that their capacity for feeling is
diminished or absent
⋆ They also describe their environment as flat ,dim in colour
, smaller ,cloudy ,dreamlike , still ,’nothing to do with me’.
⋆ The localisation of this symptoms to a particular organ is
called desomatisation (described as leg floating , feeling
of being weightless etc.)
⋆
⋆ This is a subjective experience because to outside
observer there is no loss of ability to respond.

⋆ Sedman observed that it’s best to reserve the use of this word to ‘as if
feeling ‘ rather than the experience of unreality that occurs in psychosis ;
the ‘as if ‘ affix is used by patients to denote uncertainty and that it is not
used literally
⋆ One patient described – “I feel as if my hands have broken down . Legs
have fallen off .Head has come off and fallen down”
⋆ .
⋆ But eliciting this phenomenon is not easy . The ‘as if’ content may not be
overtly expressed

⋆ NIHILISTIC DELUSIONS : here people deny their existence or of the
world as “I do not exist” ,”there is nothing in-here” , “I am dead”
⋆ SEVERE DEPRESSION STATE : Very occasionally ,depersonalisation
may occur here .Person may appear preoccupied with grief and loss of
interest . Here mistaken diagnosis of schizophrenia may be given
because patient may have great difficiulty describing depersonalisation
⋆ SCHIZOPHRENIC PASSIVITY : here patient does not describe his state
as coming from own internal experiences

Disturbances of activity of self
• In depression pt. May say his
feelings are absent or that he
cannot feel. This can be
elevated in case of guilt
feelings
• Schizophrenic pt may
longer has will of his own
.neurotic pt may describe an
inability to initiate activity
,feeling powerless
• In depression patient feels he is
unable to initiate the act of
memory or fantasy ,saying –”my
memory has gone ,I have no
thoughts ,I can’t think at all”
• Schizophrenic may feel his
activity is not initiated by him
• In schizophrenic passivity
,delusion of control patient
may feel inhibited or
retarded from outside .they
feel they can’t go
anywhere ,speech gets
arrested ,make
involuntanry movements
movement
Memorizing
and
imagining
Emotional
feeling
Willing

DISTURBANCES IN SINGLNESS / EGO CONSISTENCY /
IMMEDIATE AWARENESS OF SELF UNITY
⋆ In psychogenic and depressive depersonalisation the patient may feel
that they are talking and acting in an automatic way.
⋆ This may lead them to say that they feel ‘as if’ they are two persons .
⋆ A patient with certain delusions(for eg , delusions of demonic
possession) may also feel the same that they are 2 people(he and the
Devil)
⋆ Patients with schizophrenia may feel they are 2 or more people (although
it’s uncommon)

⋆ When this dissociation lasts longer ,disturbing the flow of thought ,that ‘doubling’ of
personality is experienced
⋆ There are 2 significant phenomenon
• Feeling of
presence
• Negative
heautoscopy
• Inner
heautoscopy
• Autoscopic
hallucination
• Out of body
experience
• Heutoscopy
proper

⋆ FEELING OF PRESENCE : the patient has a distinct feeling of the physical presence
of another person . No visual perception is usually reported . This may be confined to
one hemispace especially when the experience occurs in association with as seizure
⋆ NEGATIVE HEAUTOSCOPY : refers to failure to perceive one’s
own body own body either in a mirror or when looked at directly . Often
associated wit associated with depersonalisation.
depersonalisation
⋆ INNER HEAUTOSCOPY : refers to experience of visual
hallucinations of internal organs in extra corporal space

⋆ OUT OF BODY EXPERIENCE : during
this people seem to be awake and feel
their ‘self’ or center of awareness ,is
located outside the physical body and is
somewhat elevated . It is from this
elevated extrapersonal location that the
subjects experience seeing their body and
the world . The subject’s reported
perceptions are organized in such a way
as to be consistent with this elevated
visuo-spatial perspective.

⋆ AUTOSCOPIC
HALLUCINATIONS : said to
occur when a patient sees an
exact mirror image of himself
,or of his face or trunk
without the experience of
leaving one’s body .

⋆ HEAUTOSCOPY PROPER / DOUBLE PHENOMENON : designates a condition in
which the individual sees his double or doppelganger . The double usually appears
colourless , can behave independently ,and may or may not mirror the patient’s
appearance . There is strong self identification with the 2nd body ,often associated
with the experience of existing at and perceiving the world from 2 places at the same
time . There may be vestibular sensations such as extreme lightness of body
,sensations of flying ,elevation ,rotation .

⋆ MULTIPLE PERSONALITY DISORDER :
⋆ Morton described MPD in which the patient serially assumes a no. Of different
personalities . More than one personality embodies the same person in different
time frames . Knowledge of the other personality ,likes ,dislikes about other
personas vary across personalities
⋆ Lability in the awareness of personality. The loss of unity of self in schizophrenia
was exemplified by a patient who described how every night he became a horse
and trotted down whitehall. At the same time as this was happening in his mind, he
also believed he was in white hall watching the horse . This type of symptom is
called lability in the awareness of personality and was described by Bonhoeffer
,occuring in paranoid psychosis.

DISORDER OF CONTINUITY OF IDENTITY OF SELF
⋆ “I was there , I am here , I will be here” is a fundamental assumption of life without which
competent behaviour cannot take place.
⋆ In this type of disorder , the time perception is lost and the continuity of self
may be questioned .
⋆ In schizophrenia a person may feel that he was not the person that he was
before the illness. This may be expressed as a sense of change
⋆ In fantastic paraphrenia some may claim that “I who was there is not the
one. Mr. R. who was there is dead and I am R.” . This complete alteration in
the sense of identity of self is exclusively psychotic ,there is break in the
sense of identity of self ,and there is a subjective experience of someone
completely different.

⋆ Lesser intensity of loss of continuity occurs in non-
psychotic individuals, where even after knowing that he
is truly himself both before and after ,but feels altered
from what he was “Many things seem to have changed
,I feel I have changed” .It is not to the extent that he
actually believes this but it is more of thoughts and
feelings .

⋆ POSSESSION STATE :
⋆ There is temporary loss of both sense of personal identity and full awareness of the
surroundings.
⋆ The person acts as if he has ,and believes himself to have been taken over by
another person “ devil rides over me “
⋆ The difference between a disorder and culturally accepted phenomenon is that
disorder is unwanted ,cause dysfunction in individual and surroundings ,and may
be prolonged beyond the immediate event at which it was induced
⋆ Jaspers differentiated states of possession :
• Altered consciousness
Dissociation
(hysterical)
• Cosnciousness remains clear
Schizophrenia/
psychosis

⋆ NEAR – DEATH EXPERIENCE
⋆ Described in psychologically normal people in highly
abnormal situations like the ones who are dying or have
undergone a life – threatening experience .
⋆ Most prominent cluster of symptoms seem to be
depersonalisation , increased alertness , various
descriptions of mystic consciousness .
⋆ Out of body experience with autoscopy was as frequent
as was passage of consciousness into a foreign region
or transcendental experience

DISORDERS OF BOUNDARIES OF SELF
⋆ The distinction between what belongs to one’s body and what does not
,rests firmly on the fact that large and specialized part of afferent
nervous system is involved in obtaining information about the body
,known as propioceptive system
⋆ Eg : Anyone who has a finger anaesthetized knows that when touched it
feels like a foreign object i.e not part of his body .
⋆ The physiological schema of the body and the continuity and integrity of
memory and psychological functions is the basis for awareness of the
self

Boundaries of Self in Schizophrenia
⋆ In the alienation of personal action ,a person will not just lose control over his
thought ,action ,or feelings ,but also experience them as being foreign or being
manufactured against his will by some foreign influence .
⋆ Eg : “I feel heaviness and freezing in my head. The devil is taking CSF from my
head and that’s why these are happening “
⋆ The fundamental nature of schizophrenia appears to be the experience of invasion
of ego boundary resulting in First Rank Symptoms , which portray merging of self
with non-self

⋆ Passivity experiences are experienced as made or influenced by others and all
passivity experiences falsely attribute functions which are actually coming from
within the self to non-self influences from outside
⋆ Auditory hallucinations too have similar disturbances . Usually we think of ours self
in the 1st person singular. Ocassionally we address ourselves as “you” ,in the 2nd
person ,but we do not think about ourselves nor comment on our actions in the 3rd
person as “he” . This reveals a considerable disturbances of boundaries of self.
⋆
⋆ Similarly hearing one’s own thoughts out loud implies locating one’s innermost core
experiences in distant space exposes a massive disturbances of boundaries of self
Boundaries of Self in Schizophrenia

REFERENCES
⋆ Textbook of descriptive psychopathology (1st edition ,2018)
chapter 4 by Christoday RJ khess & Jayati Simalai
⋆ SIMS’ Symptoms in Mind(5th edition)section 4 by Femi
oyebode
⋆ Fish’s clinical psychopathology(4th edition)

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