Abstract
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. In a recent research project, informed by contemporary philosophy of mind and phenomenology, we have developed novel concepts targeting subjective disturbances of imagination and fantasy life with a focus on the schizophrenia-spectrum. Patients describe a spatialization of images, i.e., stable imagery with an articulated spatial structure being liable to inspection ‘from afar in the mind’ and often undergoing an autonomous development independently of the will of the patient (‘like watching a movie in the head’). Other notions address tacit, non-psychotic erosions of the demarcation of fantasy life from perception and memory. A broad range of ideations (such as ‘daydreams’, ‘fears’, anticipations, intrusions, paranoid or suicidal ideation) may involve such structural disturbances of experience. Here, we present data from the first, cross-sectional study investigating the distribution of anomalies of imagination in different diagnostic groups and healthy controls as well as their association with positive symptoms, negative symptoms and disorders of basic selfhood.
Methods
The sample (N=81) included in- and outpatients with schizophrenia or another non-affective psychosis (N=32), outpatients with schizotypal disorder (N=15) or other mental illness (N=16) and healthy controls (N=18). The sample was 70% female with mean age 29.9 (SD 6.8; range 18–42) years. Anomalies of imagination were assessed with the Examination of anomalous fantasy and imagination (EAFI), which is an instrument recently developed in our group for a semi-structured interview exploring these experiences. The EAFI has shown very good reliability with average Kappa of 0.84. Disorders of basic self were assessed with the Examination of anomalous self experience (EASE) and positive, negative and general symptoms with the Positive and Negative Syndrome Scale (PANSS).
Results
Anomalies of imagination aggregated significantly (p < 0.000, Kruskall-Wallis test) in the schizophrenia-spectrum disorders compared to other mental illness with no significant difference between schizophrenia and schizotypal disorder. The group of healthy controls very rarely reported these anomalies and scored significantly lower (p < 0.000) than all diagnostic groups. In multivariate linear regression analysis (R2 = 0.66), EAFI score was significantly associated with EASE score (β = 0.62, p < 0.000), PANSS positive (β = 0.34, p = 0.01) and PANSS negative (β = 0.29, p = 0.02), but not PANSS general score (β = -0.29, p = 0.07). More than 79% of the schizophrenia-spectrum patients retrospectively reported the onset of these experiences to adolescence or earlier.
Discussion
The results of this cross-sectional study support that the subjective anomalies of imagination, targeted with the EAFI, are associated with the schizophrenia-spectrum. The association with disorders of basic self, which has been shown to have trait-like characteristics and to predict transition to schizophrenia-spectrum disorders, may reflect that the anomalies of imagination share a common experiential core-structure with self disorders. We suggest that the anomalies of imagination belong to an early onset level of psychopathology in the schizophrenia-spectrum and may have a relevance for differential diagnosis and early detection.
Medical comorbidity among patients diagnosed with schizophrenia spectrum disorders - A hospital based cross sectional study