Autobiographical Self-Disturbances and Risk for Psychotic Disorders

Cowan, Henry

doi:https://doi.org/10.21985/n2-0mw8-ys06

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Autobiographical Self-Disturbances and Risk for Psychotic Disorders

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Individuals with psychotic disorders experience profound challenges in maintaining a coherent sense of self and identity over time. Although disturbances in the basic, momentary sense of self are core features of psychotic experiences, less is known about psychosis’s impact on the autobiographical self, the experience of being a coherent and unitary person across a lifetime. The autobiographical self, comprising the self-concept and narrative identity, is built in large part during adolescence and emerging adulthood, the same developmental period in which a clinical high risk for psychosis syndrome (CHR) can be identified. How is the autobiographical self affected in the CHR syndrome? Might common mechanisms explain dysfunction in various aspects of the autobiographical self? Are there any early indicators in this population of potentially more severe future autobiographical self-disturbances? Three studies addressed these questions. Study 1 examined the self-concept’s clinical and functional relevance in CHR sample (n = 73) and a matched healthy comparison (HC) sample (n = 73), finding that beliefs about the self tend to be more negative and less positive in CHR. Moreover, these dysfunctional beliefs—particularly a lack of normatively positive self-beliefs—were linked to negative attenuated psychotic symptoms, depression, and functional impairment. Study 2 tested one possible mechanism for these effects: interactions between intrinsic-self (related to inner states) and extrinsic-self (related to interactions with the environment) networks in the brain. In a subgroup of the Study 1 sample (n = 56 CHR, 59 HC), resting-state functional connectivity MRI analyses examined interactions between the cortical midline structures (intrinsic-self) and sensorimotor (extrinsic-self) networks, finding that low positive self-beliefs were associated with hyperconnectivity between these networks. Study 3 replicated and extended Studies 1 and 2 in a new sample (n = 50 CHR, 56 HC), with a larger set of self-concept variables, and added narrative identity variables coded from a life story interview. Principal components analysis in Study 3 found a broad core dysfunction in the self-concept, spanning negative self-beliefs, low self-esteem, excessive rumination, and poor self-concept clarity. This core dysfunction was associated with negativity and passivity in CHR participants’ life stories, as well as negative attenuated psychotic symptoms and functional impairment. Two aspects of the autobiographical self—a heightened tendency toward self-reflection, and possibly subtle impairments in narrative structure—were altered in the CHR group but were unrelated to the core self-concept dysfunction. Resting-state fMRI analyses were inconclusive in Study 3 due to a small and unbalanced fMRI subsample. Together, these studies built a nomological network of autobiographical self-disturbances in the CHR syndrome, showing that common mechanisms may account for a core dysfunction in the self-concept characterized by negativity and uncertainty about the self. Moreover, this core dysfunction reaches into narrative identity, in life stories marked by negativity and passivity. Finally, several key variables may be early indicators of more serious disturbances in the autobiographical self. The CHR syndrome captures a difficult period in which attenuated psychotic symptoms overlap undermine the normative development of self-concept and narrative identity. This dissertation’s findings shed light on the unique challenges that individuals face as they attempt to maintain coherent selves and identities during this difficult period. By working to understand dimensions of variability in these processes, researchers may better understand etiological mechanisms of psychosis and identity development, and clinicians may better treat their patients as individuals.

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