Disorders of

The Experience of Self

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Moderator: Presenter:
Moderator:
Dr A. K. Seth Dr Saksham Kumar
Dr Brijesh Saran
Professor & Head Assistant Junior Resident
(Dept. Of Psychiatry)Professor (Dept. Of Psychiatry)
SMCH (Dept. Of
SMCH Psychiatry)
 Introduction
• There has been a significant change in meaning of ‘Self’ for past few
years.

• It 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 an evaluation by a person as distinct from others which is important

to regulate own behaviour & to engage in social interaction.
 Aspects of self experience
Jaspers (1997) pointed out that there are four aspects of self-experience, the
awareness of :

1) Existence and self-activity

2)Being a unity at any given point in time

3)Continuity of identity over a period of time

4)Being separate from the environment (ego boundaries)

 Awareness of existence and self-activity
Awareness of ‘existence’ is an assumption that a person makes with
complete assurance that ‘I exist’.

Awareness of ‘self activity’ is the feeling that ‘I do something and I know

that I am the one who is doing this’. It is the sense of performance of
one’s own action.
 Awareness of being a unity at any given point of time
• At any given moment, person knows that he is one single person as well
as physically and socially different from others.

• In dreams, people see themselves and may feel as if they are two
persons.

• Some form of meditations can also enable a person watch himself

carrying out certain behaviour.
Awareness of continuity of identity over a period of time

• It is a feeling of permanence and continuity of ourselves from our

past into our present.

• A fundamental assumption of life without which competent

behaviour cannot take place.
 Awareness of being separate from the environment
(Ego boundaries)

• A person knows that he/she is a distinct entity apart from rest of

the world.

• This distinction b/w what pertains to one’s body and what does not
(Proprioception) is acquired in later life.

• There is a sense of knowing that “thoughts in my mind are confined

to my knowledge only”.
 Disorders of the experience of self
In descriptive psychopathology, the term ‘disorders of self’ is used to describe the abnormal inner
experiences of all four aspects of awareness of self that occur in psychiatric illnesses.

1. Disturbance in awareness of existence/being & self activity

2. Disturbance in awareness of self unity
3. Disturbance in awareness of the continuity of self
4. Disturbance of the boundaries of self
 Disturbance in awareness of
existence/being
• Alteration in the experience of existence which may sound as “I am
not alive anymore, or I am disappearing, there is nothing here”.

• It is the core experience of nihilistic delusion usually seen in

moderate to severe depressive patients.
 For Example :
I do not sense myself anymore. When someone speaks to
me, I feel as if he were speaking to a dead person. I have
to look at myself to be sure that it is I. I have the feeling
of being an absent person. In sum, I am a walking
shadow. (Minkowski, 1970)
Disturbance in awareness of self activity

• Features of depersonalization are seen.

• Patients feel detached from the body and

can watch themselves from external space.

• Complaints of absent or diminished

capacity for feeling.
 Disturbance in awareness of self activity
contd…
• Evident in 30-70% young adults at least once and may also occur in
moderately stressful situations.

• Associated with a feeling of unreality that the environment is

experienced as flat, dull or unreal (Derealisation).
 Disturbance in awareness of self unity
• A firm assumption of an individual that he/she is ‘only one single
unique person’ is lost.

• May be seen in depersonalization, dissociative identity disorder,

schizophrenia, delusion of demoniac possession, fantasies or
without any mental illness.

• Also termed as ‘autoscopy’.

 Autoscopy (Phantom mirror image)
It is an experience of perception of one’s own body image projected into the
external visual space knowing that it is he/she.

Not just merely a visual hallucination but experienced along with kinaesthetic
and somatic sensation.
Types of Autoscopy
1. Feeling of presence
2. Negative autoscopy
3. Inner autoscopy
4. Autoscopic hallucination
5. Out of body experience
6. Heautoscopy proper
(Doppelganger)
 Disturbance in awareness of the continuity of
self
Characterized by changes in the self-identity over a period of time.
Individual may feel like “I am who I was 10 years back; or I am who I will be in 10 years’
time.”

Patient may deny that they have always been the same person or they have come to
life as a new person.
Disturbance in awareness of the continuity of self contd...

• Described in the context of religious conversion or referred as

‘being born again’.

• Strong association with traumatic events such as childhood abuse.

• The experience of passivity in schizophrenia may raise doubts on

patient’s continuity from past into the present; whereas depressed
individuals may see no continuation into the future.
 Disturbance of the boundaries of self
• Patient is unable to distinguish
himself from outside
environment or people.

• Feeling of being disorganized,

distorted, dissolving, deprived
or vulnerable.

• Impairment in proprioception.
 Disturbance of the boundaries of self
contd…
• Loss of ego boundaries/demarcation.

• Passivity Phenomenon(Delusion of
control).

• Thought alienation.

• 3rd Person auditory hallucinations.

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