Disorders of self and body image Disorders of self

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These describe the abnormal inner experiences of I-ness and my-ness which occur in psychiatric disorders. Scharfetter has added the characteristic of awareness of being or ego vitality to the four formal characteristics previously described by Jaspers: feeling of awareness of activity, awareness of unity, awareness of identity, and awareness of the boundaries of self. (2,,54)

Disorder of the awareness of being

This disorder is demonstrated by nihilistic delusions, which frequently occur in severe depressive illness and are a feature of the eponymous Cotard's syndrome. (55) Non-psychotic abnormality is exemplified by depersonalization in which the sufferer experiences his mental activity, body, or surroundings as changed in quality to become unreal, remote, or automatized.

Disorder of awareness of activity

Disorder of the awareness of activity occurs with neurological lesions, such as some dyspraxias, and also in psychotic conditions in which the individual believes that no action has occurred when it has, or vice versa. This does not include action that the patient knows he has executed but with a belief it was under the influence of another. Non-psychotic disorder of activity occurs when an individual believes that he has no freedom of action and that his range of choice is limited by external circumstances, for instance a person with depressive symptoms who believes that nothing can be done to improve his state of incompetence.

Disorder of awareness of singleness

An awareness of one's essential unity implies that at any given moment 'I know that I am one person'. Disorder occurs in the rare visual perceptual experience of autoscopy.(56) Non-psychotic examples of disorder of singleness include both multiple personality disorder and the double phenomenon; the latter was described by Jaspers.(2) The essential feature of multiple personality disorder is the apparent existence of two or more distinct personalities within an individual, with only one of them being evident at any time. The double phenomenon is much more frequent, and describes the self-experience of those who feel that there are two different parts of themselves in conflict with each other, causing problems in all areas of life, but they are fully aware of both at the same time.

Disorder of awareness of identity

Disorder of identity is characterized by delusion of control or passivity experience, in which the sufferer believes that he has been taken over by an alien, with the belief that there is a break in continuity from 'myself' who was there before. Non-psychotic disorder of awareness of identity is exemplified by possession disorder, in which there is a temporary loss of the sense of personal identity and the individual may act as if they have been taken over by another personality, spirit, or force.

Disorder of the awareness of boundaries of self

Disorder of boundaries of self occurs in Schneiderian first-rank symptoms of schizophrenia such as thought withdrawal, control, and diffusion. (57) The patient believes that thoughts 'which I thought were under my own control are being taken out of me, influenced by an outside source'. Non-psychotic disorder of the boundaries of self occurs in ecstasy states, characteristically described as an 'as if experience. There is disturbance of boundaries of self in that the individual may feel that there is no limit between self and the outside world.

Depersonalization

Depersonalization is the experience of one's own feelings and experiences being detached, distant, not one's own, lost or altered. Derealization is the same range of subjectivity describing awareness of the outside world. The sufferer recognizes that this is a subjective change and is not imposed by outside forces. Because the sufferer finds it difficult to describe, this experience tends to be underdiagnosed, but the misery it causes and the disturbance in functioning is considerable; it is experienced as being so subjectively unpleasant that not uncommonly deliberate self-harm results.

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