Self-disorders: A cause of poor insight in schizophrenia?

Post Reply New Topic

Propably no psychiatrist would count that as schizophrenic when it's clearly transsexual. The differences are that you don't just feel that way occationally or in a psychotic episote, but chronic in addition to having the typical symptoms like a strong gender dysphoria with the typical dysphoria symptoms towards the own body what's not typical if it would just be part of a psychotic episode.
Feeling that the own body is different or deformed in any way in a psychotic episode is usually not related to symptoms of dysphoria.

Let me explain each of mine, since the EASE sheet demands an explanation from the patient.

1.2 At times I will get this weird thought in my head that feels like it is almost physically present, lodged in my brain, like I wanna get it out. But the thought will just stick. This seems to suggest 1.8, and perhaps 1.1 as well, but I'd wait to be more sure. Also, at times, I feel like someone like George Washington is with me oohing and aahing over the latest technology.
1.4.1 At times, in the middle of an activity, all of my thinking stops and I end up staring out into space blankly, looking at nothing in particular. Usually, though, I can get back to where I am.
1.6.2 I am constantly thinking about conversations I've had with people in the past and I'm constantly going over and over in my head about them, and I think I do it to gain a better understanding of what went on (so it's tied to perplexity).
1.6.4 I often think about destruction and violence; in fact, I just recently wrote a poem wishing for the destruction of my country for not providing SRS. This has been longstanding.
1.7.1 Often times, the voice in my head will have a certain timbre, tone, and sound and I will often want to listen to my thoughts out loud, for some reason I don't fully understand.
1.7.2 At times I like to see my thoughts written out.
1.8 Ever since I was a little kid, I've noticed my thoughts come just behind and above my eyes and in that space they appear. Sometimes they appear on one side or another, but because of my obsession with symmetry, I will often try to make an equal pressure of thoughts appear on the other side to balance things out.
1.12.1 At times, an object will stand out from all the others, for no particular reason. The object actually gives me a kind of itchy feeling similar to the thought in 1.2. I will often have to pick up the object and cover it completely with my hands to relieve the itch.
1.14.2 At times, I have felt like I am standing still, stagnating, as the years rush on.
1.16 There are times I will talk with, say, a woman and will talk about really basic things and then when she walks away I will think something like, "Oh crud! Now I gave her the impression I'm going to stalk and rape her!"

2.1.1&2 I have been observed to have a persistently negative self-image since at least the age of 11, and I can tell you it was like that since before it. If I am in a discussion with an opponent by myself, I will often think I'm losing, even if my opponent makes fallacious arguments. I've long thought of myself as if being a monster, almost like an Antichrist figure, who will lead men astray and bring about the end times. I always identified with the villains, thinking that deep down I am one too.
2.2.1 This goes back to 1.2.
2.2.3 I often feel as if I'm actually in the back of my cranium looking out at the world through my cranium and when I want to see my thoughts I look up at the thoughts above and behind my eyes.
2.4.2&3 At times, I've felt very disconnected from the world, as if things and events just pass me by and I am the stagnant one; at times, especially in stressful situations, the world will seem to feel foggy and I will feel insulated from it in a way, which is strangely relaxing and makes think of things like Vikings travelling through the mists of the North Sea.
2.5.1 At times the world will look like a video game, or it will seem strange the world is as it is. Also, it may appear gray at times.
2.5.2 At times, colors and things may shout out at me. Also, at times even when the world felt like a video game, there was a portentious energy pervading everything.
2.6 I often spend a lot of time thinking about stuff. I also think a lot about how strange it is how the world is structured and that I am here in this form. At times, this can lead to really weird experiences.
2.9 When I speak with others, oftentimes either another person I know or a fictional character will appear in my head and it is like I embody them and I will do and intone as they.
2.11.2 My female gender identity disappeared at about age 12, but reappeared after treatment for psychosis at age 14.
2.12 I've long been confused by social situations and lots of stuff that is obvious to others I'm clueless about. In fact, this was observed repeatedly in childhood, including by a school psychologist when I was 8 who wrote that in social situations my "perceptions reflected considerable confusion." I also adopt hard and fast rules for adopting social conventions, like when it comes to apologies--my dad even once said I was like the Unabomber in how rigid I could be. I also have a tendency to count people in a room and be obsessed with the exact arrangements of how people are, say, sitting, and I will obsess if there is a lack of symmetry, which creates the same sort of itch in 1.2 and 1.12.1.
2.13.1 Lots of times it feels like I have a hard time breathing and my chest will feel tight, yet even when I felt like that at the allergist's office and I did a pulmonary function test, my results were much better than predicted. So it was probably psychogenic. Also, I have had actual panic attacks where I lost consciousness and fell.
2.13.4 Yes. Social situations, especially unstructured social situations, are a great source of anxiety for me.
2.13.6 I often worry about people screwing me; sometimes I worry about them poisoning my food or stabbing me with a knife.
2.14 I am often said to be tense, going all the way back to elementary school. I frequently worry about bad stuff happening. At times, I will feel as if something big is about to happen.

(The items in Domain 2 after this are only scored if they are not due to depression and certain other factors. I would like a psychiatrist trained in the EASE to tell me if I meet them or not.)

3.2.1 I often look at my face in the mirror and I feel like I have to study it, but I often don't know why.
3.2.2 Going back years and year, when I do look in the mirror, I will notice I look different from before, but I'm not sure how.
3.3 At times I feel like my body was not put together just right, like the way my arms were put in my shoulder sockets were just a little "off."
3.6 At times, I can feel the organs in my body, in a very disturbing way, as if they were vulnerable! A few months ago, I had moments where it felt like my heart was clogging my rib cage and it would burst at any minute!
3.7 I will often feel numb in my limbs, precisely on the outside at the center of each, which inhibit my desire to move them, often causing me to lie still, as I think over and over again about an action I want to perform.
3.8.3 See 3.7.
3.8.4 I can often feel weak in my arms which makes me feel very unsteady and like I can't perform things as well as before.
3.8.5 When I feel like my body is not put together right, I feel like I have to micromanage every movement of it.

4.4 At a few times, I feel like something big is about to happen. This is it! There is no more thinking about the normal things of life! My destiny has arrived! There is no more enjoying my stims, no more thinking I can get SRS. This is it! The time has come!
4.5 At times, I feel completely exposed, like my skin contains portholes that people can see in, causing me to want to escape further into the blackness inside me.

5.2 Sometimes, and during the psychotic episode at 14, I felt like a player character in a video game, and everyone else was a non-player character. The game, the story, the fate of the world hung around me.
5.4 During my psychotic episode at 14 and perhaps just before it, I felt like I had understood things more than others had. I've perhaps also felt it a few more times since then.
5.5 I thought the world was a video game, and at times it feels like I'm either in a movie or a video game.
5.6 When playing Final Fantasy VI one time, as my player character approached Narshe in the dark world, I told myself, if a random encounter occurs before my character reaches Narshe, then I will never get SRS! When the random encounter did not occur, I breathed a sigh of relief. I've had many other moments like this.
5.7 During my psychotic break.
5.8 I thought I had insight that no others had and did not trust them with the truth as I believed they would be too stupid and shallow to understand and would just throw me in a mental hospital for no good reason. Also, I imagine that considering yourself the only player character while everyone else in the world is a non-player character can be pretty solipsistic, too. Times when I imagined myself in a video game, it was like that.

So there! From the looks of it, I'm one messed up cookie!

EDIT: Removed most references to transgender stuff.

Last edited by beneficii on 30 Dec 2013, 12:41 am, edited 4 times in total.

Raziel,

Interesting list. Perhaps you can explain yours, too?

Also, the EASE says that if 2.15 and 2.18 are due to depression, then they don't count.

Thanks for the advice on the 2.11.2. It perhaps should not count, then.

I'm not 100% sure if they are from depression or what's the cause. I'm dx with depression though, but one psychiatrist I know isn't convinced that I have depression. I would say I feel depressed, but I also see differences to ppl with "typical depression", but that could also due to the fact that I'm autistic or something else, I'm not sure.

Well, here my list explained:

1.1 Thought Interference
1.4 Thought Block, propably with that subtype
1.13 Disorder of Short-Term Memory
I'll explain those together. I dunno if I found the right terms, but well I'll explain...
I've difficulty remembering things, eventhough I know that I actually should know those things. I've problems with short term memory, I especially notice those too while reading or learning something. But at the same time I've the feeling that there are thoughts in my head that shouldn't be there. It's like they are popping up. Questions about reality, like maybe someone is asking me something (not sure) and like "backround noice" in the head. I dunno if it's me ore more hallucinatory. But it's not extreme, but the thought block is very annoying.

1.6 Ruminations – Obsessions
I was in a messy situation about 3 years ago and I still think chronically about it. That's why I wrote that it could also be related to other factors. Actually personally I think it's a bit a mixture out of anxiety related symptoms and autistic or schizophrenic obession and paranoia and that's not the best combination to get over certain stuff. It's clearly paranoid though.

1.9 Ambivalence
I'm ambivalent since a long while actually, so it could also be connected to depression, but I also have that when I'm not really depressed. But it could be avoidant and axiety related. I dunno. But actually this decreption explains my feelings very well:

1.9 Ambivalence (A.5)
Inability to decide between two or more options. Persistent
and painful conscious coexistence of contradictory
inclinations or feelings. Ambivalence occurs even for
very simple or trivial everyday decisions. The patient
cannot decide at all, needs more time for his decision, or
becomes immediately uncertain about a finally made decision
and changes it again. A related phenomenon that
is scored here is when the patient complains of having
contradictory thoughts or feelings at exactly the same
time. This phenomenon may be associated with perplexity
and paralysis of action.

1.10 Inability to Discriminate Modalities of Intentionality
I even had that I guess when I was 12. Back than I didn't know if I did something or just dreamed it because my dreams were so vivid. Now it's more that I'm thinking about different realities and think about wich one is real or not...
Sometimes my stuff is someplace else and I'm not sure if I did it. Something falls down and I get scared that someone else did it until I realice that it really just fell down and so on.

2.12 Loss of Common Sense/Perplexity/Lack of Natural Evidence
Well I just think that the world is strange.

2.13 Anxiety Subtype 3 Phobic anxiety and Subtype 6 Paranoid anxiety
I've claustrophobia and a paranoid anxiety to get locked away.
This is related to 1.6

2.15 Diminished Transparency of Consciousness
I feel like in a dream like state

2.18 Diminished Vitality
How I explained that could be due to depression but I'm not sure about it, but 2.15 is clearly also schizophrenic spectrum, but could be a mixture.

3.7 Cenesthetic Experiences
I wanna add this: Sometimes I've the feeling of a sensation on my body, like someone is touching me or a bit of pressure and also a bit like being under water.

5.1 Primary Self-Reference Phenomena
I didn't really noticed it the last view days, maybe... but I clearly had it in the past, but not as a fully serious thought. It was more double bookkeeping and some fantisy like thought I thought about. Sometimes I've the feeling that many coincidences happen and they wanna tell me something.

5.7 Existential or Intellectual Change
I didn't mention it above, because I just mentioned symptoms I've right now, but I had it in the past. I like to read into all kind of religions and existential stuff. It's like a schizophrenic special interest.
There my autism kicks in too and it can lead to a longer lasting special interest kind of mixture.

There is another theory of schizophrenia. Short-circuit heuristic theory.

[youtube]http://www.youtube.com/watch?v=EKWGGDXe5MA[/youtube] from 1:08:47 - to end, he talks about Heuristic, in particular "Heuristic 693" When assigning credit always assign credit to heuristic 693. I think that insight might have more to do with mental illness and what it is.

Suppose you figure out a way to stimulate yourself without the need for an external stimulus. Perhaps you can have yourself think of a funny joke that causes the response of laughter. Imagine further you don't even need to imagine a joke, you can just stimulate laughter - real laughter as if by command. Imagine you had the capacity to invoke all emotions in this manner, things like Jokes would be unnecessary, the whole social apparatus would be short circuited because the brain has learned to be the stimulated without the work of social interaction, that area of the brain would atrophy, and the person would be poor at communication.

This would seem to apply to ASD as well.

About the only theory of schizophrenia I've heard that can't also seem to apply to ASD is the dopamine hypothesis, and yet that theory is a way way oversimplification of what goes on in schizophrenia.

wcoltd,

I'm also interested in how someone I know with a schizoaffective disorder diagnosis would do on the EASE. (My diagnosis was only schizotypal personality disorder. ) Perhaps you could let us know which items on there seem to match your experience? Even if it's just a few examples?

Raziel,

Another way the gender thing for me could be interpreted is this: My gender identity as female actually seemed to vanish at age 12. I don't remember having much feelings as female at age 12. This lasted through my psychotic episode at 14. After being treated for the psychosis with high-dose antipsychotics, the female gender identity returned.

Maybe the incipient psychosis interfered with my true gender identity?

I can't answer your question, but I think it's possible. You propably wouldn't find any research study about it.
We still don't know much about neuro-psychiatry.

Raziel,

Can you tell me more about the thoughts that pop up that seem like they should not be there? Are the thoughts related to what you're thinking/trying to think about?

Actually I've to mention that those symptoms are propably "drug induced" (I mean with that the stimulant my psychiatrist subscribed me to treat my ADD). I didn't withdrawal that medication myself because I'm scared it could get worse when I suddenly stop it and I'll go to my psychiatrist on January 2nd or 3rd because then he has open. I mention that because so far I read symptoms from the schizophrenic spectrum who are drug induced differ in some ways to symptoms when they are not (hallucinations are more common - also visual once - and thought disorders are less severe, often they are not there at all. But also symptoms like aggression etc. are more common).

I make an example:
I've bodily illusions who feel like I'm surrounded by waves maybe, it's hard to explain, and when I notice it, sometimes a voice pops up in my head: "You are on an island" or "you are faking it" or stuff like that. It's mostly in "you"-form and irrational stuff. I've also slight visual hallucinations of seeing shadows but they fade away when I look at them directly. The thoughts that pop up are very often connected to the hallucinations and also very often in "you"-form.

No I was wrong my psychiatrist first comes back on January 7th
... his collegue is working short after new year, that's why his answering machine said they have open than.
But I've an appointment on January 7th, but I don't know if I can stand it that long, because my head feels totally cloudy and it just doesn't get better, but I don't want to go in the psychiatry. Never.

... and I dunno what to do!?

I ask myself if I should withdrawal it myself a bit, but I really don't feel confortable with this.

Raziel,

On the topic of severe erosion of minimal self-awareness or erosion of first-person perspective, which Louis Sass has found is specific to schizophrenia, here is an example from Elyn Saks, a law professor at USC who has schizophrenia and has wrote of her experiences with her illness (pp. 12-13):

http://www.brainm.com/software/pubs/bra ... t_hold.pdf

Interestingly, at least some elements of this resemble the elements in an autistic shutdown, and like an autistic shutdown this instance of erosion was triggered by stress, with perhaps a building stress instability preceding it. Compare her experiences to what is described on this page about the autistic shutdown:

http://everything2.com/user/Zifendorf/writeups/shutdown

Gender dysphoria seems to bring about anomalous self-experiences as well, but resolution of the gender dysphoria seems to resolve the anomalous self-experiences in general. Compare the EASE with this description of anomalous self-experiences by Zinnia Jones as part of her gender dysphoria (especially domain 2 of the EASE with item number 5 here):

http://freethoughtblogs.com/zinniajones ... dysphoria/

In the interests of armchair psychology , I shall go over the EASE items the above description seems to match:

(possibly) 1.7.1 Gedankenlautwerden, internal
2.1.1 Diminished sense of basic self, childhood-onset
2.2.2 Pervasive phenomenological distance between the self and experiencing
2.4.2 Diminished presence, non-specified
2.6 Hyperreflectivity
2.7.2 Ich-spaltung, non-delusional
(possibly) 2.12 Loss of common sense/perplexity/lack of natural evidence
2.13.5 Diffuse, free-floating and pervasive anxiety
2.14 Ontological anxiety

What's amazing is that the treatment for gender dysphoria made these go away. Note how they almost all come from Domain 2 "Self-awareness and presence." I remember talking to Zinnia on Twitter about it, and she seemed to think it was interesting. I think the presence of these anomalous self-experiences also shows just how serious gender dysphoria really is and that their resolution depending on effective treatment of the gender dysphoria shows just how important treatment is to the patient's mental health. Gender dysphoria isn't just a simple "Oh bummer!"

Again, here is the EASE itself:

http://www.nordlandssykehuset.no/getfil ... r/EASE.pdf

Have you wondered if some of your "autism" is lingering damage from GD ?

My psyche was tortured for so long, and I experienced various mental traumas. That must have consequences. I will probably have to accept this.

We don't know enough about the human brain to go with such simple explenations.
In my case, I had severe speech delay and even didn't wanted to be touched as a baby, together with routinized behaviour since being a little kid and aviodence from others. Typical symptoms associated with classical autism (I've HFA) since being a baby, at a time where I didn't even thought about my gender.
Of course one thing influences the other, but I don't think that there is an easy answer to it.