Among patients having their first schizophrenia episode, a tendency for suicide is strongly linked to an altered sense of self — what some experts have labeled as a “self-disorder,” according to a study of 49 patients with schizophrenia.
Self-disorders are abnormal personal experiences. They are described as “subtle disturbances of the person’s spontaneous experience of himself or herself as a vital subject naturally immersed in the world,” said psychiatrist Dr. Elisabeth Haug of the division of mental health, Innlandet Hospital Trust, Ottestad, Norway.
For the study, the researchers evaluated the relationship between self-disorders and suicide in patients who had just been diagnosed with schizophrenia spectrum disorder, as suicide risk is especially great at this stage of the disease.
Researchers studied data from the Norwegian Thematically Organized Psychosis study, which used information from all mental health treatment facilities from two counties with a total population of 375,000 people.
Of the 49 adults who had been diagnosed over a 2-year period, 38 had schizophrenia , nine had schizoaffective disorder, and two had schizophreniform disorder.
All of the patients were evaluated with the Examination of Anomalous Self Experience (EASE) manual, a 57-item questionnaire that covers five factors of self-disorders: cognition and stream-of-consciousness, self-awareness and presence, bodily experiences, demarcation/transitivism, and existential reorientation.
An example question is “Have you ever felt as if thoughts in your head don’t really belong to you?” The questionnaire then asks for descriptions or examples from the patient rather than simple yes-or-no responses. Each EASE interview took 30-90 minutes.
The findings showed that patients with newly diagnosed schizophrenia spectrum disorder also had high levels of suicidality, self-disorders and high levels of depression.
“Our main finding is that of a clear association between current suicidality and (self-disorders), which appears to be mediated by depression,” said Haug and her colleagues.
This result “strongly support(s) the role of self-disorders in the development of suicidal ideation and behavior in this patient group.”
In an earlier study, other researchers found that individuals with self-disorders experience specific feelings of inferiority and solitude, which differ from normal feelings of low self-esteem or loneliness and represent “more fundamental feelings of being profoundly dissimilar to other people and thus unable to relate to others,” noted Haug.