Redefining Disorders of the Self as Disorders of Relationship

Research Objectives: To conceptualize disorders of the self as disorders of relationship and o empirically measure the disorders of relationships

Design: Participants were involved in a longitudinal study of the neuropsychological foundations of transcendence and character traits which involved surveys and FMRIs. The current study is based on data from year 1 of the study's survey data.

To validate the proposed neuropsychological model, it was necessary to identify theoretically and statistically distinct disorders of the self for individual neuropsychological processes. Although there is no standard measure of disorders of the self (or of “relationship”), the Cambridge Depersonalization Scale (CDS) is a 29 -item objective measure of depersonalization that provides for the opportunity to test the proposed neuropsychological model.

Setting: Outpatient patients at Shepherd Center.

Participants: Participants included 73 individuals who were outpatients at a Shepherd Center including 33 with acquired brain injury (ABI) and 40 with multiple sclerosis (MS). Participants were involved in a longitudinal study of the neuropsychological foundations of transcendence and character traits. The current study is based year 1 data.

Interventions: No interventions within the study are explored in this analysis.

Main Outcome Measures: Sense of Self via metrics within the Cambridge Depersonalization Scale (CDS; Sierra & Berrios, 2000). This 29-item scale assesses the personal, subjective experiences associated with depersonalization and derealization. It assesses multiple areas of neuropsychological experience including distortions in the sense of bodily sensations, thoughts, and memory. The items are scored on a 5-point Likert scale with higher scores indicating greater degree of disordered self.

Results: Confirmatory Factor Analysis confirmed the 4 proposed distinct factors that included 19 of the 29 CDS items. Following is the variance explained by each of the factors identified in the CFA: bodily sensations (54.58%); unreality (14.65%); emotional (12.03%); Cognitive (7.24%).

Principal Component Analysis confirmed that the CDS measures a general disintegration of all neuropsychological processes. Parallel analysis using raw data supported an eight-component model.

Conclusions: Results support the proposed neuropsychological model that suggests that disorders of the self are best conceptualized as disintegrated neuropsychological processes that lack a sense of relationship to the unified experience/sense of self.

This model provides a universal neuropsychological model to explain disorders of the self as disorders of relationship and the unusual nature by which individuals with disorders of the self subjectively express their unique disintegrated experiences. That is, experiences cannot be experienced as part of the self if they are never integrated into the unified experience/sense of self.

Author(s) Disclosures: None.