Basic Self-Disturbance in the Schizophrenia Spectrum: Taking Stock and Moving Forward

Abstract

The concept of basic self-disturbance offers a renewed, phenomenologically oriented framework to approach both the cross-sectional and longitudinal complexity of schizophrenia spectrum psychopathology. According to this approach, schizophrenia is characterized by instability in the most foundational and irreducible dimension of selfhood, i.e., the basic sense of self. Whereas normal basic self-experience is characterized by being a self-present, single, temporally persistent, bodily and demarcated (bounded) subject of experience and action, vulnerability to schizophrenia is marked by several structural shifts in such a basic selfhood (e.g., unstable first-person perspective, diminished sense of presence, and loss of vital contact with reality). This provides the ground for the emergence of the varied symptoms of schizophrenia, such as positive, negative and disorganization symptoms. Recent empirical research confirms that basic self-disturbance is specific to the schizophrenia spectrum and might be of value in the prospective identification of prodromal patients. The concept has implications for both aetiopathogenetic research and clinical-psychotherapeutic intervention. Furthermore, it may offer an integrative framework across 'levels' of inquiry in schizophrenia research (i.e. across psychopathological, neurocognitive and neurobiological domains).