Psychotic self-renaming and its unique features: A case series

Background

Changing one's own name is an unusual psychotic symptom in patients with schizophrenia. Particularly, when self-renaming is neither bizarre nor grandiose, such self-renaming may be sometimes underestimated as purposeful and other times necessitates the need to differentially diagnose schizophrenia from dissociative identity disorder (DID). Although self-alteration in schizophrenia has been widely discussed, discussion from the point of view of psychotic self-renaming is lacking.

Case presentation

We present three cases with schizophrenia/schizoaffective disorder where patients changed their own names in the acute phase of their illness. We also present a case with DID for reference. Although our cases showed non-bizarre, non-religious, and non-grandiose self-renaming, this symptom was successfully treated using antipsychotic medications and modified electroconvulsive therapy, suggesting that self-renaming was associated with their psychotic symptoms. Parallel improvements in their hallucinations and delusions, and their subjective reports, indicated that the underlying pathophysiology of psychotic self-renaming was self-alteration. Greater responsivity to antipsychotics, vulnerability of surnames, an attitude of denying one's original name (not hiding the host personality), lack of amnesia, and one or only a few renaming could be features of psychotic self-renaming.

Conclusion

Our case series showed that these patients’ psychotic self-renaming was associated with their self-alteration. Our findings also provide a clinical warning to psychiatrists to not overlook treatable self-renaming in schizophrenia and misdiagnosis of DID in such patients.