Impairment of self-representation in schizophrenia: the roles of boundary articulation and self-reflexivity.

Abstract

Since the time of Kraepelin, clinicians and researchers have regarded disturbances in the sense of self as an essential feature of the clinical phenomenology of schizophrenia. Through a qualitative analysis of a schizophrenic patient's self-descriptions, this article illustrates the roles of boundary aberrations and hyperreflexivity (i.e., excessive focus on oneself) in producing the identity disturbances associated with this disorder. In this patient's self-descriptions, reflexive self-awareness resulted in confusion and perplexity, as if a core self or basic self-other boundaries were lacking altogether. In contrast, a qualitative analysis of a borderline patient's self-descriptions suggested that a sense of identity, in turn the result of better boundary articulation, was present but unstable and highly reactive to changes in mood. Psychotherapeutic implications of impairments in self-representation are discussed.