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

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  1. The Hoarding Phenomenon in Schizophrenia Spectrum Disorders

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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 first-rank symptoms.

Original languageEnglish
JournalPsychopathology
Volume53
Issue number2
Pages (from-to)103-110
Number of pages8
ISSN0254-4962
DOIs
Publication statusPublished - 2020

    Research areas

  • Anomalous self-experience, Diagnoses, EASE, Psychosis, Schizotypal disorder, Schneiderian, Diagnostic and Statistical Manual of Mental Disorders, Cross-Sectional Studies, Humans, Male, Adult, Female, Psychotic Disorders/diagnosis

ID: 60329081