Reconceptualizing Disorders of the Self as Disorders of Relationship.

Abstract

Objective: To validate a universal neuropsychological model that suggests that disorders of the self are best conceptualized as disintegrated neuropsychological processes (ie, sensations, mental experiences) that lack a sense of relationship to the unified experience/sense of self.

Design: Cross-sectional observational study.

Setting: Rehabilitation hospital outpatient clinics.

Participants: A total of 73 individuals including 33 with acquired brain injury and 40 with multiple sclerosis.

Intervention: Not applicable.

Main outcome measures: On the basis of the Cambridge Depersonalization Scale, a measure of general disintegration of sensations and mental experiences, a team of rehabilitation clinicians and researchers proposed 6 clinically derived indices of specific disintegrated neuropsychological inputs (ie, sensations), outputs (ie, mental experiences), and experiences of disintegration (ie, space, time, context).

Results: As hypothesized (1) a confirmatory factor analysis supported the proposed factors including disintegrated bodily sensations (root mean square error of approximation [RMSEA]=0.193, P=.009; comparative fit index [CFI]=0.909; Tucker-Lewis index [TLI]=0.819), disintegrated context (RMSEA=0.143, P=.129; CFI=0.970; TLI=0.911), disintegrated emotions (RMSEA=0.090, P=.266; CFI=0.967; TLI=0.902), disintegrated cognition (RMSEA=0.091, P=.210; CFI=0.963; TLI=0.939), disintegrated smell/taste, and disintegrated spatial perception (measures of model fit for these last 2 factors could not be determined given they included only 2 items); and (2) Pearson correlations indicated that all 7 Cambridge Depersonalization Scale indices were negatively correlated with a measure associated with right hemisphere functioning, with 5 achieving/approaching statistical significance.

Conclusion: The results suggest that (1) neuropsychological abilities should be conceptualized in terms of relatively singular neuropsychological domains (ie, affect, behavior, cognition, sensation) and the experience of relationship that is created when they are integrated, and (2) disorders of the self are best conceptualized as disorders of disintegration that are associated with decreased relationship between specific neuropsychological processes and the unified experience/sense of self.