Psychopathology Disorders of experience of self

1. PSYCHOPATHOLOGY
Kapil Kulkarni

2. Disorders of experience of self
Kapil Kulkarni

3. SELF
• Self is defined as the way a person thinks about
himself/ herself and views his/ her own beliefs, traits
and purpose within the world.
• It is evaluation by a person as distinct from others
which is important
i. to regulate his/ her own behaviour and
ii. to engage in social interaction
• Self-representation is central to human behaviour in
health and disease.

4. EGO AND SELF
• Ego and self are used more or less
interchangeably.
• Freud (1933) described ego as standing ‘for
reason and good sense’ and it works on the
principle of reality.

5. Introduction
• In recent decades there has been increased
interest in the study of the self, self awareness
and various changes in self-awareness, especially
in the context of mental illnesses such as
schizophrenia (Sass & Parnas, 2003; Harland et
al, 2004).
• The terms self awareness or ego consciousness
are now have been replaced by the term ‘self-
experience.’

6. Four aspects of self awareness
(Jasper,1997)
1. Awareness of EXISTENCE and SELF ACTIVITY.
2. Awareness of being in SELF UNITY at any given
point of time. (Singleness)
3. Awareness of CONTINUITY OF SELF IDENTITY over a
period of time.
4. Awareness of being separate from the environment
AWARENESS OF BOUNDARIES.
• Fifth dimension of ego vitality
(Scharfetter,1981,1995) Previously this characteristic
was part of awareness of activity, representing
awareness of existence of self.

7. • Disorders of self-experience are discussed under
these four headings, but a number of other
symptoms can be regarded as disturbances in two of
these aspects of self-experience together.
Four aspects of self awareness
(Jasper,1997)

8. DISORDERS DUE TO DISTURBANCE IN
AWARENESS OF SELF ACTIVITY

9. Awareness of SELF ACTIVITY
• Its feeling that “I do something and I know that I am
doing it.’
• There are two aspects to the sense of self-activity:
1. The sense of existence (also called Ego vitality)
“ I know that I exist”.
2. The sense of the performance of one’s actions.

10. • Depersonalisation- is a change in the awareness of
one’s own activity when person feels that he or she is
no longer his or her natural self.
.
DISORDERS DUE TO DISTURBANCE IN
AWARENESS OF SELF ACTIVITY

11. Conditions of depersonalisation
• Organic brain disease– Temporal lobe disorders (Matthew et
al, 1993)
• Substance misuse- Cannabis, LSD.
• Anxiety disorders- Agoraphobia, panic disorder, PTSD.
• Depression- occasionally
• Hysterical dissociation
• Normal people- severe exhaustion, sensory deprivation
• Medication- tricyclic anti depressants

12. Features of Depersonalisation
(Acner, 1954)
• Always subjective experience
• The experience is characterised by a feeling of
strangeness or unreality
• The experience is often unpleasant
• Insight is preserved
DISTURBANCE IN AWARENESS OF SELF
ACTIVITY

13. Clinical features of depersonalisation
• Third most frequent symptom to occur in psychiatry
after anxiety and depression. (Stewart, 1964)
• It is often associated with derealisation in which
person feels that environment experienced is unreal.
• Usually occurs in attacks which may last from
seconds to hours.
DISTURBANCE IN AWARENESS OF SELF
ACTIVITY

14. • Typically, in depersonalisation disorder, attack lasts
for a few hours, in temporal lobe epilepsy for a few
minutes and in anxiety disorder for a few seconds.
• The first attack is usually very frightening and
patients often think that they are going mad.
• However in course of time they may become more or
less accustomed to it.
Clinical features of depersonalisation
DISTURBANCE IN AWARENESS OF SELF
ACTIVITY

15. DISTURBANCE OF AWARENESS OF SELF
ACTIVITY
• Depression and high anxiety like phobia can manifest
as problems with perception own actions and
movements
-- in a patient of severe depression “I do not feel
alive, my body is dead and my eyes are staring towards
you out of a dead body”
– patient suffering from phobia saying “ if I am in lift,
I panic and feel as if I am falling over”

16. • Depression can cause problems with memorizing
and imagination– depressed patient feels that he is
unable to initiate any act of memory or fantasy.
• Depression causes loss of feeling – A depressed
patient feels, “ I cannot love my parents as before.
Nothing has happened between to us but I have just
lost my feeling for them.”
DISTURBANCE OF AWARENESS OF SELF
ACTIVITY

17. DISORDERS DUE TO DISTURBANCE IN
IMMEDIATE AWARENESS OF SELF
UNITY (SINGLENESS)

18. Awareness of SELF
UNITY (Singleness)
• Feeling that at any given moment ‘I know that I am
one person.’

19. DISTURBANCE IN IMMEDIATE
AWARENESS OF SELF UNITY
• In dreams- person sees himself/ herself and feels as
is they are two persons.
• In some forms of transcendental meditation, by
carrying out repetitive monotonous acts, the person
enters in a self-induced trance in which he can
observe himself carrying out certain behaviour.

20. • In depersonalisation- the patient may feel that they
are talking and acting in an automatic way as if they
are two persons.
• Schizophrenia and delusion of demonic possession
(may feel they are two or more people)
DISTURBANCE IN IMMEDIATE
AWARENESS OF SELF UNITY

21. Autoscopy (phantom mirror image)
• It is an experience of perception of one’s
own body image projected into the
external visual space (Lukianowicz, 1958)
• “Patient can see himself and knows that it
is he. Autoscopy is not just a visual
hallucination because it is experienced
with kinaesthetic and somatic sensation.”
(Fish, 1967 )
• Especially associated with disorders of
parietal lobe.
DISTURBANCE IN IMMEDIATE
AWARENESS OF SELF UNITY

22. The Double phenomenon: Dopple ganger
• It is an awareness of oneself as being
both outside alongside, and inside
oneself: the subjective phenomenon
of doubling.
• Seen in – fantasy, depersonalization,
compulsive ideas, double personality
(alternating states of consciousness),
without any mental illness.
DISTURBANCE IN IMMEDIATE
AWARENESS OF SELF UNITY

23. Dual, double or multiple personality
• Experiencing multiple personalities ---In multiple
personality disorder. (dissociative identity disorders)
• Delusional misidentification or Capgras syndrome
DISTURBANCE IN IMMEDIATE
AWARENESS OF SELF UNITY

24. • Double orientation; is the situation where an
individual appears to live in two worlds
simultaneously– a psychotic world and the real
world.
• For example a confused patient on a psychogeriatric
ward he believes that this man came to visit him is
doctor and also the person who came to marry his
young wife.
Dual, double or multiple personality
DISTURBANCE IN IMMEDIATE
AWARENESS OF SELF UNITY

25. DISORDERS DUE TO DISTURBANCE OF
CONTINUITY OF SELF IDENTITY

26. Awareness of
CONTINUITY OF SELF IDENTITY
• It is a feeling that “I am who I was last week, or 30
years ago: I am who I will be next week, or in 10
years time.”

27. DISORDERS DUE TO DISTURBANCE OF
CONTINUITY OF SELF IDENTITY
• Psychosis: complete alteration in the sense of
identity. Patient feels he is not the same person that
he was before the illness. --religious new life or being
born again.
• Normal health people, neurosis and personality
disorder: A feeling of loss of continuity with lesser
intensity. Patient with depression may feel that
“everything is dark and there is nothing to look
forward in to future.”

28. DISORDERS DUE TO DISTURBANCE OF
CONTINUITY OF SELF IDENTITY
• Possession state:
In normal people under hypnosis. It can also happen
in certain cultural or religious context.
• Near death experience:
Often seen in depersonalisation and characterised by
increased alertness, out of body experience, mystic or
spiritual consciousness.

29. DISORDERS DUE TO DISTURBANCES IN
BOUNDARIES OF SELF

30. Awareness of BOUNDARIES OF
SELF
• Nothing but “I can distinguish what is myself from
the outside world that is not myself”
• One of the most fundamental of the experience is
the difference between one’s body and the rest of
the world.

31. • Seen in schizophrenia-
• In schizophrenia, the sense of invasion of self appears to
be fundamental experience especially with first rank
symptoms.
• Controlling and passivity phenomenon e.g. somebody is
controlling my mind with radio waves, my actions are not
my own actions.
• Thought alienation phenomenon e.g. my thoughts are
being stolen or broadcasted.
• Auditory Hallucination (3rd person): Patient confidently
says that voices are coming from some place far from
them, where as in fact they arise inside the self.
DISORDERS DUE TO DISTURBANCES IN
BOUNDARIES OF SELF

32. DISORDERS DUE TO DISTURBANCES IN
BOUNDARIES OF SELF
• Meditations and religious practices: Person might
describe experiencing unity with saints or God or
universe.
• LSD intoxication

33. DISORDERS DUE TO DISTURBANCE IN
BODY IMAGE

34. Awareness of BODY
• The body schema in the picture of our own body in
our mind.

35. DISORDERS DUE TO DISTURBANCE IN
BODY OF IMAGE
• Distortion of body image– anorexia nervosa, obesity.
• Dislike of body– Transsexualism, Dysmorphophobia
• Undue concern with appearance– Narcissism
• Undue concern with illness– Hypochondriasis

36. Thank you
Further reading….