Josef Parnas

• MD, DrMedSci
• Consultant at University of Copenhagen

This classic text by the German psychiatrist Karl Wilmanns stands out as exceptional in the literature describing the psychopathology of mentally ill homeless people. Wilmanns’ psychopathological descriptions are excellent, as are his observations of the disheartening failure to recognize dementia praecox in courts, prisons and workhouses, and the...

This classic text by the German psychiatrist Karl Wilmanns stands out as exceptional in the literature describing the psychopathology of mentally ill homeless people. Wilmanns’ psychopathological descriptions are excellent, as are his observations of the disheartening failure to recognize dementia praecox in courts, prisons and workhouses, and the...

What are the neural correlates of conscious experience? In their article “Beyond task-response- Pre-stimulus activity modulates contents of consciousness”(Northoff et al., 2024), the authors provide an account of what they see as neglected neurophysiological features of so-called neural correlates of consciousness (NCCs) studies. The NCC program tr...

Introduction: In this paper, we wish to elucidate alterations of basic existential and intersubjective configurations in schizophrenia spectrum disorders (SSD) through the phenomenon of Anderssein ("feeling different"). Anderssein is an important yet neglected notion from German psychiatry, referring to a specific sense of feeling profoundly diffe...

Schizophrenia continues its resistance to the pathogenetic understanding. We believe that one of the reasons is an oblivion of schizophrenia's characteristic Gestalt expressive of its psychopathological structure. In this article we argue for a crucial role of disorders of selfhood in the constitution of this Gestalt. First, we present a phenomenol...

Elevated resting heart rate (RHR) and reduced heart rate variability (HRV) are signs of autonomic nervous system dysfunction identified in schizophrenia (SCZ). This dysfunction has been found to manifest prior to the onset of the clinical diagnosis. Yet whether such autonomic dysfunction is associated with vulnerability to schizophrenia remains unk...

Background and hypothesis Assigning a psychiatric diagnosis in real-world situations is often difficult, given that the clinical presentation does not usually conform to the list of condensed, simplified behavioral descriptors of mainstream operational taxonomies (MOT) (eg, ICD-11 and DSM-5). The goal of this study was to benchmark diagnostic accur...

Background and hypothesis: Nonpsychotic symptoms (depression, anxiety, obsessions etc.) are frequent in schizophrenia-spectrum disorders and usually conceptualized as comorbidity or transdiagnostic symptoms. However, in twentieth century, foundational psychopathological literature, many nonpsychotic symptoms with specific phenomenology (here terme...

Moritz et al¹ present an informative picture of the vicissitudes of first rank symptoms throughout the evolution of DSM from II-5. Moreover, they suggest a Schneider-inspired redefinition of auditory verbal hallucinations with a relaxation of the demand that such hallucinations have a clear perceptual quality. Reading this thought-provoking paper l...

Aim: Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self-disturbance model of psychosis by examining the relationship between specific clinical, neuroco...

Double bookkeeping is a term introduced by Eugen Bleuler to describe a fundamental feature of schizophrenia where psychotic reality can exist side by side with shared reality even when these realities seem mutually exclusive. Despite increasing theoretical interest in this phenomenon over the recent years, there are no empirical studies addressing...

This study presents phenomenological features of auditory verbal hallucinations (AVH) in schizophrenia and associated anomalies of experience. The purpose is to compare the lived experience of AVH to the official definition of hallucinations as a perception without object. Furthermore, we wish to explore the clinical and research implication of the...

Background Nonpsychotic symptoms (depression, anxiety, obsessions etc.) are frequent in schizophrenia-spectrum disorders. Twentieth century foundational psychopathological literature claimed that certain nonpsychotic symptoms (here termed pseudoneurotic symptoms) are relatively closely linked with the schizophrenia-spectrum, despite descriptive ove...

Background and Hypothesis The idea that a disorder of the basic self is a central feature in schizophrenia has recently been corroborated in a meta-analysis and a systematic review. Manifestations of the self-disorder can be systematically explored with the Examination of Anomalous Self-Experience (EASE). In this study, we examined the factorial st...

Obsessive-compulsive symptoms are frequent in schizophrenia-spectrum disorders and often cause differential diagnostic challenges, especially in first-contact patients. Drawing upon phenomenology of cognition, we critically review classic and contemporary psychopathological notions of obsessive-compulsive phenomena and discuss their relevance for d...

Hallucination is defined in the diagnostic systems as an experience resembling true perception without causal stimulus. In this second report from an in-depth phenomenological study of schizophrenia patients experiencing auditory verbal hallucinations (AVHs), we focused on the phenomenological qualities of AVHs. We found that a substantial proporti...

Introduction: The concept of schizophrenia (SCZ) was originally associated with a disorder of formal strata of the self. During the last two decades, empirical studies have demonstrated a selective hyper-aggregation of self-disorders in the SCZ spectrum. As with other scientific research areas, the role of self-disturbances in SCZ has been up for...

Aim: The notion of a disturbed self as the core feature of schizophrenia dates back to the founding texts on the illness. Since the development of the psychometric tool for examination of anomalous self-experience (EASE), self-disorders have become accessible to empirical research. Empirical studies have shown that EASE measured self-disorders pred...

Background Anomalies of imagination encompass disturbances of the basic experiential structure of fantasies and imagery that can be explored in a semi-structured way with the Examination of Anomalous Fantasy and Imagination (EAFI). We aimed (1) to examine the distribution of anomalies of imagination among different diagnostic groups and a group of...

Eugen Bleuler, the founder of the concept of schizophrenia, pointed out that psychotic patients were able to live in two disjoint worlds (namely, the social, intersubjective world and the delusional world). He termed this phenomenon "double bookkeeping," but did not provide any conceptual elaboration of this phenomenon or its possible mechanisms. D...

Background: To prevent or delay the onset of psychotic disorders or ameliorate their course, prodromal research has strived to identify and treat individuals at risk of developing psychosis. While this approach is laudable, it is, however, not entirely unproblematic from clinical and conceptual perspectives. For example, it remains unclear how we...

Disordered selfhood in schizophrenia was rediscovered at the turn of the millennium. In 2005, Psychopathology published the psychometric instrument, the Examination of Anomalous Self-Experience (EASE). In this article, we summarize the historical background of the creation of the EASE, explicate the notion of the disorder of basic or minimal self w...

Background: Formal thought disorder was constitutively linked to the original concept of schizophrenia and has since been one of central features supporting its diagnosis. Bleuler considered formal thought disorder as a fundamental symptom of schizophrenia among other fundamental symptoms, including ego disorders. The contemporary concept of self-d...

Introduction The distinction between the schizophrenia spectrum and other types of disorders may be clinically relevant in terms of its predictive validity as suggested by studies showing schizophrenia spectrum patients have more unfavourable outcomes compared to other psychotic disorders. The present study aimed to investigate whether basic self-d...

Disturbed self-experience has been reported as a characteristic feature of schizophrenia since the first formulation of its diagnostic concept; however, only in the last 2 decades an explicit notion of basic Self-disturbance, or Self-Disorders (SD), has emerged as target for a systematic research program. We conducted systematic searches in bibliog...

Mishra et al. have in the current issue written a critical remark to our previously published article “Altered self-recognition in patients with schizophrenia” (Sandsten et al. 2020). We are surprised by the issues they choose to address. It seems to us that most of their remarks reflect a misunderstanding of our study. We in the following paper ad...

The differential diagnosis of obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies...

We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities...

The presence of hoarding behavior among patients with schizophrenia has been known for more than a century. Nevertheless, only a few studies have examined the hoarding phenomenon among patients with schizophrenia, and no studies have examined the potential motivation. Hoarding disorder became a separate diagnosis in DSM-5. Studies about hoarding di...

Schizophrenia (SCZ) can be characterized as a basic self-disorder that is featured by abnormal temporal integration on phenomenological (experience) and psychological (information processing) levels. Temporal integration on the neuronal level can be measured by the brain's intrinsic neural timescale using the autocorrelation window (ACW) and power-...

Background Imagination is the formation of ideas or images of something known not to be present to the senses. Clinical psychopathology has few notions addressing this domain apart from obsession and rumination. Some classic psychopathological notions such as Jaspers’ concept of pseudohallucination or the pseudo-obsession are relevant to this area....

Recent reviews on auditory verbal hallucinations (AVHs) advocate a qualitative and interdisciplinary research that not only is limited to single descriptive features, but also involves contextual issues and co-occurring psychopathology. In this study of mainly readmitted patients with the International Classification of Diseases, Tenth Revision, di...

During the first half of the twentieth century, German psychiatry came to consider ‘ Ich-Störungen’, best translated as self-disorders, to be important features of schizophrenia. The present text is a translation of a chapter by the German psychiatrist Hans Gruhle, which is extraordinarily clear and emblematic for this research line. Published in 1...

Levels of Analysis in Psychopathology - edited by Kenneth S. Kendler April 2020

Levels of Analysis in Psychopathology - edited by Kenneth S. Kendler April 2020

Self-alienation is a common characterization of various disturbing experiences in patients with schizophrenia. A vivid example comes frompatient reports of not recognizing themselveswhen inspecting their specular image in the mirror. By applying the multisensory paradigm of the Enfacement Illusion, this study empirically addresses the specular Self...

Background and goals: Recent studies indicate that basic self-disorder (SD) is a core clinical phenotype of schizophrenia and its spectrum. The goal of the present study was to test the degree to which SD characterizes the pre-onset phase of schizophrenia-spectrum disorders (SSD). A secondary goal was to replicate previous findings regarding the l...

Background: The integration of various domains or levels of analysis (clinical, neurobiological, genetic, etc.) has been a challenge in schizophrenia research. A promising approach is to use the core phenomenological features of the disorder as an organising principle for other levels of analysis. Minimal self-disturbance (fragility in implicit fi...

In contemporary consciousness research, we have defended a position of experiential minim-alism, arguing that for-me-ness (or minimal selfhood) is a necessary, universal feature of phenomenal consciousness. The concept of for-me-ness refers to the fact that experiences are given first-personally to the subject of experience. To challenge the univer...

Purpose We aimed to evaluate the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as a potential means of improving on the SCID's diagnostic efficacy. Methods 76 first-admission patients were assigned DSM-IV consensus diagnoses by two experienced psychiatrists using all available information, then dichotomized into non-affective psychosis an...

This monographic issue of Thaumàzein is the second part of a research that aims to investigate the possible relationship between specific psychopathological symptoms and a series of crucial questions of philosophy, such as: Anthropogenesis and Phenomenology of Emotions; Intersubjectivity and Direct Perception of Expressivity of the Other; Phenomeno...

The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the “transdiagnostic” approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This...

A potential link between creativity and mental illness has been a longstanding topic for human studies and empirical research. The major problem is defining creativity and establishing its measurable indicators. A few high-quality epidemiological studies have been undertaken and point to a link between creativity and vulnerability to mental illness...

In contemporary consciousness studies, a central question concerns the nature of the most primitive and fundamental features of phenomenal consciousness. Some authors (e.g., Zahavi) have argued that for-me-ness (or minimal selfhood) is a fundamental and necessary feature of phenomenal consciousness. The concept of for-me-ness articulates that exper...

Predictive prospective studies of schizophrenia date back to the late 1950s. At the turn of the Millennium, an Australian research group initiated programs of early detection of schizophrenia and early therapeutic intervention. The theoretical foundations of early schizophrenia detection usually remain unaddressed. In this paper, we focus on the is...

Self-disorders have been hypothesized to be an underlying and trait-like core feature of schizophrenia-spectrum disorders and a certain degree of temporal stability of self-disorders would therefore be expected. The aim of the study was to examine the persistence of self-disorders measured by the Examination of Anomalous Self Experiences over a tim...

The purpose of this article is to show how schizophrenia, understood as a distortion of the most intimate structures of subjectivity, illustrates the nature of subjectivity as such, while at the same time how philosophical considerations may help to understand schizophrenia. More precisely, schizophrenic experiences of self-alienation seem to refle...

This review provides a brief overview of key historical, conceptual and empirical aspects of the link between creativity and psychosis. The genius and his or her tendency to madness constitute the historical backbone of this link, although ambiguous interpretations and substantial conceptual change characterise this mad genius hypothesis. Some empi...

This paper serves as an introduction to the Examination of Anomalous Fantasy and Imagination (EAFI) - a novel instrument for a semistructured, phenomenological exploration of psychopathology of imagination. We present an account of the phenomenology of imagination and proceed to a presentation of the disorders of imagination that are addressed in t...

The Examination of Anomalous Fantasy and Imagination (EAFI) is an instrument for a semistructured, phenomenological exploration of psychopathology of imagination. The EAFI provides a conceptual-descriptive framework to address such experiences. It consists of 16 main items, sometimes divided into subtypes. We suggest that the anomalies of imaginati...

Several research trends in contemporary psychiatry would benefit from greater emphasis on detailed assessment, modelling dynamic change, and micro-level analysis. This may assist with clarifying nosological and pathoaetiological issues. We make this case by referring to three areas: psychopathology and nosology; prediction research; and ‘big N’ dat...

Background Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance (SD) refers to a disruption of the sense of first-person perspective and self-presence that is associated with a variety of anomalous subjective experiences. Recent st...

Background Phenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to a disruption of the sense of first-person perspective and self-presence that is associated with a variety of anomalous subjective experiences. Recent cross-s...

This article examines the clinical concept of delusional atmosphere or mood, which denotes a predelusional state that may precede the formation of primary delusion in schizophrenia. Delusional mood refers to a global, diffuse, ominous feeling of something (not yet defined) impending. This article explores how schizophrenia spectrum patients usually...

This article explores some of the major views of selfhood in modern philosophical and psychopathological literature, including the distinction between minimal-experiential and narrative-personal self, and it presents a simplified classification of how different levels of selfhood can be disturbed in different mental disorders. It proposes that schi...

The status of borderline personality disorder (BPD) as a diagnostic category is a matter of continuing controversy. In the United States, BPD is one of the most frequent diagnoses of psychiatric inpatients, and a similar tendency emerges in Europe. Nearly all theoretical aspects of BPD have been questioned, including its very position as a personal...

Historical and current research on borderline personality disorder reveal certain affinities with schizophrenia spectrum psychopathology. This is also the case for the borderline criteria of "identity disturbance" and "feelings of emptiness," which reflect symptomatology frequently found in schizophrenia and schizotypal personality disorder. Unfort...

Background and Aims: Adolescents at clinical high risk for psychosis (CHR), as defined by the presence of attenuated psychosis symptoms (APS), exhibit increased levels of suicidal ideation and behavior. However, no research thus far has examined the link between basic self-disturbances (SD), an established marker for CHR, and suicidality/self-harm...

Aim: The goal of this pilot study was to assess the association between basic self-disturbance (SD) and deficits in neurocognitive and metacognitive functioning among help-seeking adolescents with and without attenuated psychosis syndrome (APS). Methods: Sixty-one non-psychotic, help-seeking adolescents (age 13-18) were assessed with the examina...

The aim of the study was to compare social cognition between groups of patients diagnosed with schizophrenia and healthy controls and to replicate two previous studies using tests of social cognition that may be particularly sensitive to social cognitive deficits in schizophrenia. Thirty-eight first-admitted patients with schizophrenia and 38 healt...

This article explores the phenomenologically informed, theoretical and empirical research direction on self-disorders in the schizophrenia spectrum conditions. First, we describe the concept of ‘self’ that is operative in the concept of ‘self-disorders’ and we discuss how this self may be disordered or fragile in the schizophrenia spectrum. Second,...

Streszczenie Skala EASE jest listą objawów do częściowo ustrukturalizowanego fenomenologicznego badania subiektywnych lub empirycznych nieprawidłowości (anomalii), które można uznać za zaburzenia podstawowej, „minimalnej” samoświadomości. EASE opracowana została na podstawie samoopisów otrzymanych od pacjentów chorujących na zaburzenia ze spektrum...

While investigating social cognitive impairments in schizophrenia, prominent evidence has been found that patients with schizophrenia show a tendency to misclassify neutral stimuli as negatively valenced. Within this population, patients presenting delusions are more prone to this phenomenon. In a previous study, Schizophrenia spectrum (SzSp) patie...

cusing also on schizotypal traits, would be necessary. For example, one study demonstrated that healthy subjects with few schizotypal traits (not warranting a clinical diagnosis) score higher on self-disorders than healthy subjects completely free of schizotypal features [9]. In the study by Madeira et al. [1] , diagnoses were allocated by treating...

The “EAWE: Examination of Anomalous World Experience” is a detailed semi-structured interview format whose aim is to elicit description and discussion of a person's experience of various aspects of their lived world. The instrument is grounded in the tradition of phenomenological psychopathology and aims to explore, in a qualitatively rich manner,...

Lo scopo di questo articolo è esplorare il sé e i disturbi che registra nella schizofrenia. Un numero consistente di studi empirici, infatti, evidenzia come il sé riporti dei disordini nei disturbi dello spettro schizofrenico ma non in altre patologie mentali. Questo solleva almeno due importanti que-stioni: quale concetto di sé è implicato nel dis...

In this article, we explore the self and its disturbance in schizophre-nia. An accumulating amount of empirical studies testify that the self is disturbed in schizophrenia spectrum disorders but not in other mental disorders (Parnas & Henriksen 2014). This raises at least two important questions: what concept of self is implied in the self-disturba...

Attenuated psychotic symptoms (APS) are the key criteria to identify the individuals at enhanced risk of developing psychotic disorders. Competing clinicians-rated or self-rated psychometric instruments can also be used to detect APS, which makes it difficult to interpret their actual clinical significance. This article summarizes the empirical dif...

Abstract Background The concept of self-disorders in schizophrenia has gained substantial interest and it has now been established empirically that self-disorders aggregate in schizophrenia-spectrum disorders but not in other mental disorders or in healthy controls. Yet, the issue of temporal persistence has not been addressed. Aim The aim of th...

Aims: To explore whether the diagnostic homogeneity in a daily, routine clinical activity changed visibly over two historical periods (the ICD-8 and the ICD-10 era) across and within five psychiatric in-patient clinics. Methods: In this register study, we analyzed the discharge diagnoses from five university-affiliated departments of psychiatry...

van Os and Reininghaus’ paper on the transdiagnostic “extended psychosis phenotype” attempts to present an exhaustive framework for the nosology and pathogenesis of psychiatric and especially psychotic disorders1. We have there the genes, gene‐environment interactions, an emphasis on the role of childhood trauma (resurrected after a period of skept...

Mysticism and schizophrenia are different categories of human existence and experience. Nonetheless, they exhibit important phenomenological affinities, which, however, remain largely unaddressed. In this study, we explore structural analogies between key features of mysticism and major clinical-phenomenological aspects of the schizophrenia spectru...

Background and goal: Recent findings have provided preliminary support for the notion that basic self-disturbances (SD) are related to prodromal symptoms among nonpsychotic help-seeking adolescents. As a sizable proportion of adolescents who are at risk do not seek help, this study attempts to assess the extent to which these findings can be gener...

The introduction of polythetic diagnostic classification (DSM-III and ICD-10) in psychiatry was anticipated to improve the reliability of psychiatric diagnoses, facilitate research, and eventually allow the then future DSM-IV to become anchored in objective, etiological criteria. However, the preparations and release of DSM-IV and DSM-5 highlighted...

Vivid mental imagery occurs frequently in schizophrenia spectrum disorders (SSDs). Overlapping phenomena, such as obsessions or ruminations, are also frequent in other psychiatric disorders, raising significant diagnostic challenges. Unfortunately, contemporary operational psychopathology lacks the epistemological and phenomenological framework to...

The release of DSM-5 and the preparations for the launch of the ICD-11 provoked a series of critiques of psychiatric classification, which continues to depend largely on clinical description. Among the immediate problems are those of arbitrary diagnostic thresholds, tendency to reification, rigid category boundaries, comorbidity, diagnostic 'epidem...

Background Empirical studies of rationality (syllogisms) in patients with schizophrenia have obtained different results. One study found that patients reason more logically if the syllogism is presented through an unusual content. Aims To explore syllogism-based rationality in schizophrenia. Method Thirty-eight first-admitted patients with schizo...

Although hallucinations are among the most studied psychiatric symptoms, their pathogenesis remains largely unknown and their experiential complexities are rarely accounted for. In schizophrenia, auditory verbal hallucinations are by far the most frequently reported type of hallucination. In this study, we explore verbal hallucinations in schizophr...

schizophrenia, psychosis, auditory verbal hallucinations, pathogenesis, and etiology The first commentary that we discuss is the quite critical one by Thomas and Long-den (2015). The pertinent question is if the authors’ criticism hits the mark or if it is simply off the mark? We will let the reader decide. In the following, we address some of the...

Objectives: In 2011 Anders Behring Breivik, ABB, slaughtered 77 civilians in a twofold attack in Oslo and on the island of Utøya, Norway. During his trial ABB's sanity or lack thereof was fiercely contested. Two psychiatric evaluations arrived at radically different diagnoses of psychosis and personality disorder respectively. Though unrivalled in...

this paper describes new phenomenology-oriented directions of research. Bridges may be brought between cognitive sciences and psychopathology.

What do psychiatrists encounter when they encounter psychopathological experience in their patients? How should we interpret such experiences? In this chapter, we contrast a checklist approach to diagnosis, which is standard today and which treats psychiatric symptoms and signs (i.e., "the psychiatric object", Marková & Berrios, 2009; see also Chap...

Examination of Anomalous Self-Experience (EASE) är en symtom-checklista för en semistrukturerad, fenomenologisk undersökning av upplevda eller subjektiva anomalier, som kan anses vara störningar av basalt eller ”minimalt” självmedvetande. EASE har utvecklats med utgångspunkt i självbeskrivningar från patienter med schizofreni-spektrumstörningar, oc...