Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
Psychology, Northwestern University, Evanston, IL, USA.
Schizophr Bull. 2024 Jul 27;50(4):848-859. doi: 10.1093/schbul/sbad142.
Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course.
Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning.
CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning.
This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.
在青少年晚期和成年早期，叙事自我和个人身份的紊乱伴随着精神病性障碍的发作（自我概念和个人叙事的形成性发展阶段）。然而，这些问题主要是在疾病发作后进行回顾性研究，限制了对其发展过程的任何推断。
处于精神病高危状态的青年（CHR）（n=49）和匹配的健康对照组青年（n=52）完成了生活故事访谈（包括自我定义记忆、转折点、生活挑战和类精神病体验）和自我评估问卷，包括自尊、自我信念、自我概念清晰度和沉思/反思自我焦点。经过培训的评估员对访谈进行了叙事身份主题的编码，包括情感基调、能动性、时间连贯性、上下文连贯性、自我事件联系和意义建构（组内相关系数>0.75）。统计分析测试了组间差异以及自我概念、叙事身份、症状和功能之间的关系。
CHR 参与者报告了更低的自尊和自我信念、更差的自我概念清晰度和更多的沉思自我焦点，所有这些都与阴性症状有关。CHR 参与者讲述的生活故事主题是消极情绪和被动性（即缺乏个人能动性），这与阳性和阴性症状有关。反思自我焦点和自传体推理没有受到影响，而且相关。自传体推理与保留的角色功能独特相关。
这组处于 CHR 的年轻人表现出了一些但不是所有在精神病性障碍中看到的自我概念和叙事身份的变化。消极性、不确定性和被动性是他们语义和叙事自我表现的核心主题。保留的自我反思和自传体推理表明存在弹性的来源和认知行为和元认知干预的潜在立足点。
