Self-structure in schizophrenia

Exploring identity and personal meanings in psychosis using the repertory grid technique: A systematic review

Current research and clinical practice in person-centred approaches highlight the importance of self, identity, and personal meanings in psychosis. Previous research has focused on dimensions of self, but less attention has been paid to the personal meanings involved in identity. The personal construct theory framework and the repertory grid technique (RGT) allow the study of identity and personal meanings within person-centred approaches of psychopathology and treatment in psychosis, as suggested by studies that began more than 40 years ago. However, their contributions have not yet been reviewed. We aimed to systematically review the evidence for the role of identity and personal meanings in psychotic disorders. We performed a systematic search using personal construct and RGT terms in PsycINFO, Web of Science, PubMed, EBSCO, Scopus, and Google Scholar. After identifying 2,574 articles, 15 were included. Nine studies followed an idiographic assessment, and six were nomothetic. Patients reported their subjective experience of isolation in terms of high self-ideal discrepancy and high perceived discrepancy with their significant others, which some studies associated with a lower degree of recovery or with the way in which positive symptoms were construed. Self-fragmentation either decreased with interventions or was associated with recovery. Evidence regarding interpersonal construing was less consistent, but there was a tendency for patients to show a more rigid cognitive structure than controls. To conclude, we found some evidence that self-discrepancies, fragmentation of self, and interpersonal construing are affected in psychosis and potentially modifiable through psychotherapy.

Redefining outcome measures in schizophrenia: integrating social and clinical parameters

PURPOSE OF REVIEW

Schizophrenia is a complex neurobehavioral disorder for which there are many promising new treatments. There is, however, a discrepancy in outcome measure reports when they are obtained from patients, relatives, caregivers, or professionals, making it difficult to determine the level of recovery. This lack of agreement may result from limitations of the measurement tools themselves, which are not comprehensive and may be measuring different aspects of outcome. Alternatively, it could be that the conceptual understanding of outcome and recovery require development.

RECENT FINDINGS

For various reasons, patients assessed as 'recovered' remain excluded from mainstream society. We are of the opinion that present outcome measures do not capture real-life situations. We propose that the concept of recovery be carefully defined and the gold standard of outcome should incorporate social and clinical parameters. We attempt to redefine recovery. Patients who have shown clinical improvement do not necessarily do well in everyday situations even though there is obvious clinical improvement. Therefore, it has been repeatedly argued that a consensus of recovery should be determined and that routine clinical practice should then adapt to the agreed criteria.

SUMMARY

We argue that the outcome measures should be multidimensional and consist of at least two parameters: clinical remission and social outcome.

Identity related to living situation in six individuals with congenital quadriplegia

PURPOSE

This study was a preliminary examination of structural aspects of identity, particularly identity associated with living situation, in individuals who have quadriplegia due to cerebral palsy.

METHOD

A hierarchical classes algorithm (HICLAS) was used to construct idiographic 'identity structure' models for three individuals who are living in an inpatient hospital setting and for three individuals living in community-based group residences.

RESULTS

Indices derived from the models indicate that the identity 'myself as one who has a disability' was structurally superordinate (i.e., resided at a high hierarchical level) for all six participants, suggesting a high level of importance of this identity in participants' sense of self. The models also indicate that while identity associated with one's particular living situation was superordinate for persons living in the hospital, it was not for persons living in community residences.

CONCLUSIONS

While conclusions based on this small sample are necessarily limited, the data suggest that identity associated with living situation might differ in structural centrality, and presumably subjective importance, for persons living in inpatient versus community-based settings.

Using Hierarchical Classes to Analyze Organization of the Self-Concept

This study evaluated in several ways the concurrent and discriminant validity of measuring self-concept organization via Hierarchical Classes (HICLAS) analysis of interview-derived self-descriptions. College students (N = 85) listed and then described using their own words various self-aspects, and they completed standardized measures of depressive symptoms, self-esteem, and verbal ability. As expected, self-views were multifaceted and hierarchically organized. The proportion of negative self-descriptors provided was positively correlated with depressive symptoms and negatively correlated with self-esteem. Positive and negative self-descriptors were compartmentalized across self-aspects. These results supported the concurrent validity of the information yielded by HICLAS analysis. Supporting the discriminant validity of the method, indices of the elaboration of the self-concept were not correlated with depressive symptoms. No HICLAS variables were significantly confounded by individual differences in verbal ability. We conclude that HICLAS analysis of self-generated descriptors is a promising, flexible method of idiographic assessment of self-concept organization.

The self and schizophrenia: a cognitive approach

The aim of the study was to explore the basic features of self-schema in persons with schizophrenia. Thirty two schizophrenic patients and 32 normal controls were asked to select personality trait words from a check-list that described themselves, themselves as they were five years ago, and what most people are like. Compared with the control group, participants from the experimental group chose significantly more adjectives that were common to descriptions of self and others, and significantly less that were common to self and past-self descriptions. These results suggest that schizophrenic patients experience their personality as changing over time much more than do healthy subjects. Moreover, their self-representation seems to be less differentiated from others-representation and less clearly defined than in normal subjects.

Hierarchical classification and the integration of self-structure in late adolescence

A number of empirical studies have demonstrated that one's self-concept is multi-dimensional in nature, varies according to social context, and shows increased differentiation throughout adolescence. There has been relatively less work, however, examining the integration of multi-dimensional social selves. Rosenberg and Gara's (1985) model of the multidimensional self (a model that utilizes a statistical procedure called "hierarchical classification" or HICLAS) was employed to investigate the integration of social selves during late adolescence. First- and fourth-year college students (n=128) completed a computer program designed to collect data required to construct HICLAS "self-structures". The findings indicated that the social selves of fourth-year college students were more related conceptually and were more differentiated than the social selves of first-year students. The differences between first- and fourth-year students suggested that hierarchical classification procedures could be used to address developmental hypotheses.

Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses

BACKGROUND

Increased rates of schizophrenia continue to be reported among the African-Caribbean population in England.

AIMS

To evaluate the competing biological, psychological and social explanations that have been proposed.

METHOD

Literature review.

RESULTS

The African-Caribbean population in England is at increased risk of both schizophrenia and mania; the higher rates remain when operational diagnostic criteria are used. The excess of the two psychotic disorders are probably linked: African-Caribbean patients with schizophrenia show more affective symptoms, and a more relapsing course with greater social disruption but fewer chronic negative symptoms, than White patients. No simple hypothesis explains these findings.

CONCLUSIONS

More complex hypotheses are needed. One such links cultural variation in symptom reporting, the use of phenomenological constructs by psychiatrists and social disadvantage.

Mental representation, severe psychopathology, and the therapeutic process

Mental representation is a central construct in psychological development. A method for assessing the developmental level of representation of self and significant figures is described, and changes in the developmental level of these representations are reported in a sample of forty seriously disturbed, treatment-resistant adolescents and young adults in intensive, psychoanalytically oriented inpatient treatment lasting more than a year. Increased differentiation-relatedness of descriptions of self and significant figures (mother, father, and therapist) was significantly correlated with improved clinical functioning. Over the course of treatment, representations moved from descriptions of self and significant figures dominated by polarization and splitting to representations involving the emergence and consolidation of object constancy. Improved clinical functioning was correlated with more positive descriptions of self, mother, and therapist and, paradoxically, with more negative descriptions of father. Two prototypical case studies of these self- and significant-figure descriptions are presented, one for a borderline patient and one for a schizophrenic. Intense negative affect, predominantly anger, and a relative preservation of self-reflexivity are typical of the self- and object representations of borderline individuals, but representations in schizophrenic individuals are characterized by affective muting and marked disturbance in reflexive self-awareness. The assessment of cognitive-affective schemas of self and significant others provides a method for investigating therapeutic change and for identifying important differences among various forms of psychopathology.

The abused child as parent: the structure and content of physically abused mothers' perceptions of their babies

OBJECTIVE

The major aim of the study was to provide an empirical answer to the following question: Does a mother's history of being physically abused as a child have a discernible impact on the structure and content of her perceptions and beliefs concerning her own child?

METHOD

Free-response memories and current descriptions of babies, self, and significant others such as parents were compared longitudinally in two groups of mothers when their babies were 6 months, 1 year, and 2 years old. One group of mothers consisted of individuals who reported being physically abused as children; the control group consisted of mothers who were not physically abused. The two groups were comparable with respect to age of baby, race, and socioeconomic status.

RESULTS

Abused mothers were found to differ significantly from control mothers in the structure and content of their free-response perceptions of their own babies. More specifically, abused mothers lagged behind controls in how well-differentiated were their negative perceptions of their babies. Differentiation in this study is operationally defined as the number of unique clusters that underlie a mother's perceptions of her baby, when social perception data is analyzed using cluster analysis (HICLAS). The greater the number of clusters observed, the greater is the differentiation. On the other hand, abused mothers were comparable to controls with respect to differentiation of positive perceptions of babies.

CONCLUSIONS

The findings constitute a discovery about the structural organization of social cognition in mothers at-risk for child abuse. Implications of the findings for theory and future research are briefly discussed, as are limitations of the current study.

Self-structure and self-transformation in group psychotherapy

This article first outlines a theory of self-structure as a hierarchically organized multiplicity of versions of self. It then describes self-transformation as a two-part process: (Part 1) the articulation and strengthening of individual self-boundaries, and (Part 2) the reclaiming of split-off, denied, or projected aspects of self. Clinically, both parts are products of the communicative interaction among members, the therapist, and the group as a whole. A parallel conception of group development posits that the group, as an object and as a social system, also needs to: (a) articulate and strengthen its boundaries so that it may (b) contain the sustained interdependent, sometimes conflictual, interactivity among members that is essential to the self-reclaiming process.

Identity disturbances and self-other differentiation in schizophrenics, borderlines, and normal controls

The present study investigates identity disorders in schizophrenics and borderlines. Nineteen schizophrenics and 17 borderlines were compared with 18 normal controls. The technique used was an adapted version of the repertory grid test to describe the self and nine significant others (i.e., family members). Three indices were derived from the 10 person x 20 self-generated-attribute matrix to measure the extent to which self was differentiated from others: (1) overlap of salient attributes, (2) overlap of opposite attributes, and (3) degree of differentiation among others. Results showed that both schizophrenics and borderlines describe themselves more in terms of opposites than in terms of salient attributes. Differentiation among significant others was severely impaired in schizophrenics and preserved in borderlines. These findings were interpreted as a failure of the individuation process in schizophrenics and as an incomplete construal of self-identity in borderlines.

The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions

In this paper we review a series of recent investigations into cognitive abnormalities associated with persecutory delusions. Studies indicate that persecutory delusions are associated with abnormal attention to threat-related stimuli, an explanatory bias towards attributing negative outcomes to external causes and biases in information processing relating to the self-concept. We propose an integrative model to account for these findings in which it is hypothesized that, in deluded patients, activation of self/ideal discrepancies by threat-related information triggers defensive explanatory biases, which have the function of reducing the self/ideal discrepancies but result in persecutory ideation. We conclude by discussing the implications of this model for the cognitive-behavioural treatment of paranoid delusions.