Psychopathology最新文献

This paper proposes a critical expansion of phenomenological psychopathology of the individual to explicitly integrate the collective dimension. In order to accurately describe the scenario of collective life, and its relationship with the psychology and psychopathology of individual existences, we propose two moves: (1) A shift of focus from society (which denotes an organized aggregate of individuals) to culture (a transversal symbolic system, capable of extending beyond the boundaries of the original social group), since in the context of advanced globalization the conception of stable social aggregates has been replaced by models of fluid and changing "cultural flows". (2) To phenomenologically describe these cultural flows that traverse the contemporary world, we introduce the concept of "cultural existentials" (time, space, body, and others) as a priori conditions of experience derived from the analysis of the fundamental structures of individual lifeworlds, as employed in phenomenology. These cultural existentials are integrated into a Dialectical Experiential Matrix (DEM), designed to overcome the reductionism of both structuralism and subjectivist individualism. The DEM frames the patient's experience as a dynamic interplay between individual freedom (the capacity for self-positioning) and cultural influence. An illustrative application analyzing the convergence between "pornographic culture" and the "homo œconomicus" anthropological type is provided to demonstrate how cultural existentials offer a collective model for specific narcissistic vulnerabilities and dysregulations of alterity, providing a crucial diagnostic device for the clinician.

Objective: Felt presence (FP) is the experience that another entity is present in one's proximal environment, despite no sensory evidence. Occurrence of FP is linked to psychosis risk, but qualities of FP in the context of psychosis are not well understood. We conducted an online, exploratory survey assessing qualities of FP in relation to psychosis risk in the general population.

Methods: Three hundred and seventy-six participants completed an anonymous online survey consisting of validated measures of sensed presence, psychosis risk, loneliness, trauma, resilience and general mental health. They also responded to questions about perceptual qualities of FP. We investigated the role of the presence and its qualities in predicting psychosis risk, and relationships between qualities of FP and psychosis risk. We also examined the relationships between qualities of FP and psychosocial variables with psychosis risk.

Results: FP and anxiety significantly predicted elevated psychosis risk. FP experiences in the high-risk group were more frequent, distressing, vivid, and multisensory than in the low-risk group. Specifically, distress during FP significantly predicted psychosis-risk status over and above demographic and psychiatric covariates (including anxiety). Cumulative trauma was linked with total number of FP experiences as well as increased frequency, distress, vividness, and understandings of FP's identity. Depression, anxiety, and stress were associated with more physiological sensations and increased distress during FP, as well as knowledge of FP's identity. Resilience was associated with more frequent and vivid FPs.

Conclusions: These results demonstrate strong links between FP and psychosis risk in the general population and provide preliminary evidence of qualitative markers that differentiate FP from psychosocial factors in the context of psychosis risk. Assessment and clinical conceptualizations of risk for schizophrenia should consider including experiences of bodily self-disturbance, such as FP.

Background: According to the standard definition, a hallucination is (1) a perceptual experience occurring in the absence of a relevant perceptual object, (2) it has the sense of reality of a veridical perception, and (3) it is unwilled and not under voluntary control of the hallucinator. This definition is supposed to encompass all hallucinations, across mental disorders and experiential modalities.

Summary: In this article, we examine the standard definition's validity by comparing visual hallucinations in delirium and auditory verbal hallucinations (AVHs) in schizophrenia, focusing especially on the definition's second criterion, i.e., the sense of reality criterion. Our analysis reveals stark differences between these two disorders, their concomitant experiential structures, and the experience of hallucinations. While hallucinated objects are experienced as real in both disorders, they are typically not experienced as real in the same sense of the term. In delirium, hallucinatory objects are experienced as real in the way perceptual objects are, and they often are indistinguishable from such objects. In schizophrenia, by contrast, hallucinatory objects are often not experienced as real in the way perceptual objects are, and they often are distinguishable from such objects.

Key message: An appreciation of the different kinds of sense of reality of hallucinations is relevant for developing more precise psychopathological concepts, clinical care, and empirical research. Based on our findings, we offer a revision of the standard definition of hallucination, making it valid for the variety of hallucinations that are found across mental disorders.

Introduction: The present paper identified key components of anxiety and fear based on a large community sample of 387 psychiatrically healthy or depressed participants.

Methods: Subfactors were defined based on a principal component analysis with promax rotation and characterized via correlations with other psychiatric as well as physiological and volumetric indicators collected in this large study.

Results: The key components were labeled "discomfort," "fright," "nervousness," "lack of self-confidence," and "worry." We discuss the components according to their organizational complexity, but also in terms of their affective and motivational content.

Conclusion: The components may be useful for future research, as they are based on three of the most-used psychiatric questionnaires assessing anxiety and fear symptoms.

Introduction: Delusions frequently involve strong beliefs about, or interactions with, illusory social agents. Although such agents have been systematically described in hallucinations, few studies have investigated their nature and identity in delusions.

Methods: We identified 205 electronic mental health records describing the content of delusions from the Clinical Record Interactive Search platform at South London and Maudsley NHS Foundation Trust. Delusional content was classified as non-social, implicitly social, or explicitly social. Descriptions of illusory social agents from explicitly social delusions were extracted and categorized using an upward coding analysis. A hierarchical cluster analysis identified distinct groupings of illusory social agents.

Results: Most delusions (83.4%) contained explicit references to illusory social agents. Across 238 instances, we identified 220 distinct agent identities, with a mean of 1.17 agents per record. The majority were humans (85.1%), most often identified as family members (31.0%), followed by acquaintances (17.2%), religious figures (13.2%), unnamed persons (12.8%), professionals (11.8%), and cultural figures (10.9%). Hierarchical clustering revealed two distinct groups: one including socially proximate agents and the other more socially distant agents. These findings indicate a social gradient in delusions.

Conclusion: Social content predominates in delusions, with patients experiencing delusions about socially closer individuals more frequently. We discuss the extent to which social gradient may not be unique to delusional misidentification syndromes but may instead represent a general feature of delusions. Better characterization of social agents in delusions could inform mechanistic accounts of these symptoms and, in clinical practice, guide family support and risk assessment.

Introduction: In biomedicine, entity experiences are conceptualised as compound hallucinations featuring living beings. The term "experience" suggests that these have an objective basis in reality, as those perceiving them may maintain. So-called jinn encounters, typically described by Muslims with and without a psychiatric diagnosis, involve the multimodal perception of a spirit that, as described in the Qur'an, was created by Allah.

Methods: We conducted a phenomenological investigation among Muslim patients residing at Parnassia Psychiatric Institute, The Hague, mostly diagnosed with a schizophrenia spectrum disorder. To enquire specifically into multimodal hallucinations featuring jinn or related entities, we used the Hallucination Attribution List, a tailor-made, semi-structured questionnaire.

Results: Of the 42 interviewees, 35 described multimodal hallucinations, of which 22 fulfilled the criteria of entity experiences involving 2 to 6 sensory modalities simultaneously. Twelve participants (54.5%) were fully convinced they were dealing with jinn; the others left some room for doubt. Although we did not quantitatively assess the levels of jinn-associated distress, all participants characterised their experiences as impressive and impactful.

Conclusion: Multimodal hallucinations may involve full-blown entity experiences, which in Muslim patients typically take the form of jinn encounters. The way in which these entity experiences are mediated is as yet uncertain. However, since visual, auditory, and tactile hallucinations in our sample were described substantially more frequently than somatic, olfactory, and gustatory ones, we hypothesise that the processes underlying the hallucinations may be driven by a stochastic mechanism in that the first three sensory modalities need to have been engaged before the latter three can be recruited. We highlight several biological models of potential underlying mechanisms as well as two overarching models that may help place the mechanisms in the wider context of personal, social, cultural, religious, philosophical, and evolutionary factors that, conceivably, all play a role in their mediation.

Background: The phenomenon of love is an important task for the psychopathologist since love experience is the site in which the Self is formed and potentially dismantled. This paper explores "one-way love" - an autotelic form of love that persists independently of return. It may serve as a way for the person to sustain a sense of autonomy finding fulfilment in the act of loving itself - a paradoxical affirmation of identity, existence, and autonomy.

Summary: The analysis unfolds three central functions of one-way love: (1) it frees the person from dependency on the Other's love; (2) it preserves the integrity of the lover's own desire protecting it from the confrontation with the Other's desire; (3) it offers the lover a heroic and noble self-image rooted in fidelity to feeling. One-way lovers may appear as dependent on a beloved who does not reciprocate, but they are firmly convinced that they are performing a radical act of freedom: loving not to be loved in return, but to assert their own existence as a person fully capable of loving.

Key message: One-way love is a strategy in which desire and fear intersect, sustaining the beloved at a distance and affirming the lover's capacity to love without dependence. Yet, this autonomy carries a cost: it prevents genuine intimacy with the Other. By avoiding the vulnerability required to share private aspects of the Self, one-way lovers evade the very encounter with otherness that is essential to the ongoing development and transformation of the Self.

Introduction: Severe anger and overt aggression are common phenomena in borderline personality disorder (BPD) which have serious negative consequences for those affected and their environment. New developments in psychotherapy for personality disorders aim to target etiological mechanisms involved in psychopathology. Since affect dysregulation is a prominent biobehavioral mechanism underlying overt aggressive behavior in BPD, we aimed to clarify whether a psychotherapy that has been shown to decrease aggression in BPD does indeed modulate this mechanism.

Methods: Accordingly, the neural effects of a novel mechanism-based anti-aggression psychotherapy (MAAP) were compared to those of a nonspecific supportive psychotherapy (NSSP). Twenty-seven highly overt aggressive patients with BPD and 29 healthy controls were included in this functional magnetic resonance imaging (fMRI) study.

Results: The BPD patients treated with MAAP showed an increase in neural activation in clusters comprising the left anterior insula, the right dorsomedial prefrontal cortex (PFC) and the bilateral anterior caudate being related to a reduction in overt aggression. In contrast, the BPD group that had received NSSP exhibited a decrease in activity in the aforementioned clusters, each associated with a rise in overt aggressive behavior. Furthermore, MAAP showed an increase and NSSP a decrease in context-dependent functional connectivity between the caudate seed cluster mentioned above and the left dorsolateral PFC. Likewise, this interaction effect was negatively related to the change in overt aggression with an OAS-M reduction for the MAAP and a rise for the NSSP group.

Conclusion: The data may suggest that the aggression-reducing effect of MAAP is mediated through increasing cognitive control over dysregulated feelings of anger.

Background: The shift in mental health towards ecological and collaborative models, in alignment with the recovery paradigm, has sparked interest in dialogical and coproductive practices. These practices aimed to promote epistemic justice and strengthen the therapeutic alliance. Among these, collaborative writing (cowriting) is emerging as a promising tool. However, it currently lacks a robust theoretical and methodological foundation, particularly in its integration with phenomenology and its clinical applications. This article proposes the core elements of a "phenomenological cowriting" model that seeks to frame the practice within clinical phenomenology, distinguish it from purely narrativist approaches, and highlight its unique contributions.

Summary: This study conducts a theoretical analysis with a focus on clinical applicability, integrating the principles of clinical phenomenology with collaborative and dialogical methods. The relevance of a phenomenological cowriting model is demonstrated through a comparative analysis with other collaborative writing approaches, such as those based on narrativist or ethnographic traditions, and is exemplified by a case vignette. From a clinical perspective, we propose a three-phase model: (1) therapeutic dialogue, (2) the use of transcription as a "textual artefact," and (3) joint rewriting. This model provides significant value in terms of process and outcomes. As a process, it embodies a collaborative care framework that minimises epistemic asymmetry and promotes patient agency. As an outcome, it helps clarify the patient's lived experience, including its prereflective dimensions, thereby enriching shared psychopathological knowledge with a first-person perspective.

Key message: Phenomenological cowriting should be understood not as a mere technique but as a comprehensive and integrated model of care. Grounded in clinical phenomenology and the coproduction of a text, it provides a structured method for constructing therapeutic pathways that foreground an active role for the patient, ultimately generating clinical knowledge rooted in the subjective experience of suffering.

Background: Felt presence (FP) - the sensation of someone nearby without sensory evidence - is common in healthy adults and related to psychosis risk. FP may arise from a misattribution of internal signals to an external source and often occurs when people are alone. Interoception, the ability to perceive one's own bodily signals, may help distinguish oneself from others. FP could relate to interoception across several dimensions: through altered signal perception (interoceptive accuracy), insight into their perception (interoceptive insight), and/or self-reported beliefs (interoceptive beliefs). This is the first study that investigates this potential relationship.

Method: A total of 55 healthy adults completed the heartbeat counting task to assess interoceptive accuracy and insight under three "social" conditions: self-view (observing oneself on a screen), other view (being observed by the experimenter on a screen), and baseline (no viewing). Participants completed the Prodromal Questionnaire-16 to screen for psychosis risk, the Inclusion of Other in the Self Scale as a measure of self-other overlap, the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), and indicated whether they ever had a "felt- or sensed-presence experience" (Y/N).

Results: Psychotic experiences were elevated in individuals with FP, and it was experienced more often in solitude. Overall, the other-view condition reduced both interoceptive accuracy and insight. Distinct interoceptive patterns emerged for FP and psychosis risk. High risk was related to lower interoceptive accuracy, particularly when perceived self-other overlap was low. In contrast, individuals with FP showed intact interoceptive insight when the self-other overlap was low. Both FP and psychosis risk were associated with lower trust in bodily signals and tendency to not distract oneself from bodily sensations. Only FP group reported attending to bodily sensations to calm oneself.

Conclusion: Interoceptive accuracy was preserved in those with FP regardless of their psychosis risk, but their trust of and insight into their own bodily signals were reduced. This mismatch may lead to misattributing internal signals to external sources, contributing to FP. However, preserved interoceptive accuracy may support self-regulation, potentially offering a protective effect. These results highlight the potential of interoceptive training to enhance resilience in individuals at risk for psychosis.