Associations between Self-Disorders and First-Rank Symptoms: An Empirical Study

Abstract

Background: The diagnostic weight of the first-rank symptoms was deemphasized in DSM-5 and a similar change is expected in ICD-11. This change was motivated by a lack of solid, empirical evidence of the diagnostic significance of first-rank symptoms for schizophrenia. Yet, it seems that Schneider's original concept of first-rank symptoms was overly simplified when it was introduced in DSM-III. Specifically, it was overlooked that first-rank symptoms, in Schneider's understanding, fundamentally involve a disorder of the self. The aim here is to empirically test Schneider's claim that first-rank symptoms involve self-disorders. Methods: In a modified, cross-sectional study of 98 first-admission patients, the relation between lifetime presence of first-rank symptoms and self-disorders was examined. Self-disorders were examined with the EASE (Examination of Anomalous Self-Experiences). Results: We found an odds ratio of 1.56 (95% CI 1.10-2.21) for having first-rank symptoms for each 5-point increase in the EASE (measuring self-disorder) using a generalized linear mixed model regression. We did not find first-rank symptoms in the absence of self-disorders. Conclusion: The close relation between first-rank symptoms and self-disorders seems to support Schneider's original concept of first-rank symptoms. We suggest that first-rank symptoms occurring without the pervasively altered self-experiences might not be different from other psychotic phenomena in terms of their diagnostic significance. Awareness of self-disorders can help clinicians in assessing and detecting firstrank symptoms.

Relating self‐disorders to neurocognitive and psychopathological measures in first‐episode schizophrenia

“…Significant correlations between SD's and both positive and negative symptoms have however been reported in previous studies in schizophrenia spectrum samples (Nordgaard & Parnas, 2014;Raballo & Parnas, 2012). Moreover, a correlation between SD's and Schneiderian first-rank symptoms have been reported (Nordgaard et al, 2020) which is in line with the notion that SD's constitute an antecedent of Schneiderian phenomena (Fuchs, 2015). Lack of correlation between SD's and IQ found in our study accords previous studies (Nordgaard et al, 2015;Nordgaard & Parnas, 2014).…”

Self-monitoring in schizophrenia: Weighting exteroceptive visual signals against self-generated vestibular cues

“…For instance, it is well-documented that patients experience numerous perceptual distortions of self-generated stimuli ( Bleuler, 1950 ; Frith et al, 2000 ; Haggard, 2017 ; Kraepelin, 1913 ; Schneider, 1959 ). This includes the commonly reported feeling that one's own actions and thoughts are caused by another agent ( Brunelin et al, 2007 ; Farrer and Franck, 2007 ; Fourneret et al, 2001 ; Fourneret et al, 2002 ; Knoblich et al, 2004 ; Nordgaard et al, 2019 , Nordgaard et al, 2020 ; Synofzik et al, 2010 ; Whitford, 2019 ). Unusual bodily sensations (e.g., feelings of movement, pain, numbness, or of being electrified) ( Rajender et al, 2009 ; Röhricht and Priebe, 2002 ; Stanghellini et al, 2014 ) are also commonly reported in schizophrenia and are among the earliest subjectively experienced symptoms ( Schultze-Lutter, 2009 ).…”

Prevalence and assessment of self-disorders in the schizophrenia spectrum: a systematic review and meta-analysis

“…It must be noted that in Nordgaard et al 's 2020 study on FRS 33 , some patients with schizophrenia but no FRS have been included as controls; as such it would be inaccurate to assume that there were no patients with schizophrenia in the control group. To deal with this issue, we did an additional sensitivity analysis removing this study (also see "Methods" section for three-level analysis for dependent effect sizes).…”