Despite being a relatively new concept, psychiatric comorbidity, i.e. the co-occurrence of two or... more Despite being a relatively new concept, psychiatric comorbidity, i.e. the co-occurrence of two or more mental disorders, has become widespread in clinical practice and psychiatric research. In this article, we trace the origin of the concept of psychiatric comorbidity, discuss the conceptual literature and point to basic problems concerning inadequate definition of the concept, differential diagnostic issues, and reification of mental disorders. We illustrate how these problems may have consequences for diagnostic assessment in current clinical practice and psychiatric research. To address some of the problems related to psychiatric comorbidity, we discuss potential principles for assessing psychiatric comorbidity. Inspired by Feinstein's original concept of comorbidity in general medicine and his differential diagnostic principles, we emphasize the importance of independence of mental disorders when assessing psychiatric comorbidity. We suggest that knowledge of trait v. state conditions and of the multitudinous clinical manifestations beyond what is captured in the diagnostic manuals may be helpful for assessing the independence of mental disorders and thus psychiatric comorbidity. We further argue that a more hierarchical diagnostic system and explicit exclusionary rules could improve clinical practice and research by reducing informational complexity and combating unwarranted psychiatric comorbidity.
Disordered selfhood in schizophrenia was rediscovered at the turn of the millennium. In 2005, Psy... more 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 with the help of phenomenological philosophy, and provide a brief description of clinical manifestations targeted by the EASE. We also present our personal experience using and teaching the EASE and summarize the empirical evidence obtained so far. We conclude that the basic self-disorder represents a crucial phenotype of schizophrenia spectrum disorders and that this phenotype offers a potential avenue to empirical pathogenetic research and psychotherapeutic treatment.
Obsessive-compulsive symptoms are frequent in schizophrenia-spectrum disorders and often cause di... more 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 differential diagnosis between obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders. The classic psychopathological literature defines true obsession as intrusions with intact resistance and insight and regards these features as essential to the diagnosis of OCD. In schizophrenia, the classic literature describes pseudo-obsessive-compulsive phenomena characterized by lack of resistance and an affinity with other symptoms such as thought disorder and catatonia. By contrast, the notions of obsession and compulsion are broader and conceptually vague in current diagnostic systems and research instruments. Here, these phenomena overlap with delusions as well as various subjective and behavioral anomalies, which we discuss in detail. Furthermore, we examine a link between obsessive-compulsive phenomena and disturbances of basic structures of experience in schizophrenia-spectrum disorders addressed in contemporary psychopathological research. We suggest that these experiential alterations have relevance for differential diagnosis and early detection in this complex symptom domain.
Here, we report the first systematic, empirical findings regarding
salient subjective experiences... more Here, we report the first systematic, empirical findings regarding salient subjective experiences termed anomalies of imagination. These disturbances can be assessed with the psychopathological instrument, Examination of Anomalous Imagination and Fantasy (EAFI), in a semi-structured interview. In a cross-sectional sample, we investigated their diagnostic distribution and correlations with dimensions of schizophrenia-spectrum psychopathology.
Background: Anomalies of imagination encompass disturbances of the basic experiential structure o... more 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 healthy controls, and (2) to examine their relation with disorders of basic self, perceptual disturbances and canonical state psychopathology of the schizophrenia-spectrum (positive, negative and general symptoms).
Methods: The 81 participants included patients with schizophrenia or other non-affective psychosis (N = 32), schizotypal personality disorder (N = 15) or other mental illness (N = 16) and healthy controls (N = 18). The assessment encompassed EAFI, Examination of Anomalous Self-Experience (EASE), parts of Bonn Scale for the Assessment of Basic Symptoms (BSABS) and Positive and Negative Syndrome Scale (PANSS). For network analysis, the associations of EAFI with the other psychopathological variables were tested by Pearson's correlation coefficient and graphically represented using multidimensional clustering. Comparisons between correlations in the network were tested with Steiger's test.
Results: Anomalies of imagination aggregated significantly in schizophrenia-spectrum disorders compared to other mental illness and healthy controls with no difference between schizophrenia and schizotypal disorder. In the network analysis, anomalies of imagination were closely inter-connected with self-disorders. Although, the anomalies of imagination correlated moderately with perceptual disturbance and positive, negative and general state symptomatology, these dimensions aggregated separately and relatively distant in the network.
Conclusions: The results support that anomalies of imagination are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders.
Background Imagination is the formation of ideas or images of something known not to be present t... more 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 rang...
European Archives of Psychiatry and Clinical Neuroscience, 2019
The differential diagnosis of obsessive-compulsive disorder (OCD) and schizophrenia-spectrum diso... more 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 such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession ('with resistance') and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clini-cian. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizo-phrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive-compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.
Abstract
The Examination of Anomalous Fantasy and Imagination
(EAFI) is an instrument for a semis... more Abstract 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 imagination explored by the EAFI reflect an alteration in the structure of consciousness and belong to a fundamental, generative layer of psychopathology with relevance to differential diagnostic purposes.
Abstract
This paper serves as an introduction to the Examination of
Anomalous Fantasy and Imagina... more Abstract 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 the EAFI. Furthermore, the interrater reliability of the EAFI was examined in a diagnostically heterogeneous sample of 20 in-patients. The interrater agreement ranged from 0.6 to 1.0, with an average κ of 0.84. The internal consistency of the EAFI as measured by Cronbach’s α was above 0.88. We suggest that the anomalies of imagination explored by the EAFI reflect an alteration of the structure of consciousness and belong to a fundamental, generative layer of psychopathology. These disorders may have relevance for differential diagnostic purposes, especially in first-contact, young patients.
Internal vivid imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenome... more Internal vivid imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenomena, like obsessions or ruminations are also frequent in other psychiatric disorders, raising significant diagnostic challenges. Unfortunately, contemporary psychiatry does not possess a sufficiently nuanced conceptual framework to address these important issues. After a brief historical discussion, we provide a novel, phenomenological account of anomalous imagination in the schizophrenia spectrum disorders. Drawing on illustrative patients’ self-descriptions, we report a perceptualized imagery, radically deviating from normal imagination. This account points to an eroded structure of the first-person perspective. The anomalous imagery acquires spatialization, spatio-temporal constancy, explorability, autonomy, and a sense of experiential distance between the subject and the imagined content. The sense of the irreality of the phantasy may become compromised. We propose that pathology of imagination is an important aspect of psychopathology in the schizophrenia spectrum, with a diagnostic relevance and a potential for systematic empirical studies.
Vivid mental imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenomena... more Vivid mental imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenomena, such as obsessions or ruminations, are also frequent in other psychiatric disorders, raising significant diagnostic challenges. Unfortunately, contemporary operational psychopathology lacks epistemological and phenomenological framework to address such questions. Using the resources of phenomenology and philosophy of mind, we articulate the structure of imagination and describe its distinctive modifications in the schizophrenia spectrum disorders. Drawing on the pilot data with patients’ self-descriptions, we present the notion of perceptualized imagery. The anomalous imagery acquires spatialization, spatio-temporal constancy, explorability, autonomy, and a sense of experiential distance between the subject and the image. As a quasi-perceptual, stable object, such imagery often evokes intense affective response whereas the normal sense of "irreality" of the phantasy may become compromised. We articulate these anomalies of imagination as being entailed by the underlying generative disorder of schizophrenia, namely the disorder of minimal self (unstable ipseity or first-person perspective). We propose that pathology of imagination is an important psychopathological aspect of the schizophrenia spectrum, with significant relevance for early diagnosis and differential diagnosis.
Despite being a relatively new concept, psychiatric comorbidity, i.e. the co-occurrence of two or... more Despite being a relatively new concept, psychiatric comorbidity, i.e. the co-occurrence of two or more mental disorders, has become widespread in clinical practice and psychiatric research. In this article, we trace the origin of the concept of psychiatric comorbidity, discuss the conceptual literature and point to basic problems concerning inadequate definition of the concept, differential diagnostic issues, and reification of mental disorders. We illustrate how these problems may have consequences for diagnostic assessment in current clinical practice and psychiatric research. To address some of the problems related to psychiatric comorbidity, we discuss potential principles for assessing psychiatric comorbidity. Inspired by Feinstein's original concept of comorbidity in general medicine and his differential diagnostic principles, we emphasize the importance of independence of mental disorders when assessing psychiatric comorbidity. We suggest that knowledge of trait v. state conditions and of the multitudinous clinical manifestations beyond what is captured in the diagnostic manuals may be helpful for assessing the independence of mental disorders and thus psychiatric comorbidity. We further argue that a more hierarchical diagnostic system and explicit exclusionary rules could improve clinical practice and research by reducing informational complexity and combating unwarranted psychiatric comorbidity.
Disordered selfhood in schizophrenia was rediscovered at the turn of the millennium. In 2005, Psy... more 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 with the help of phenomenological philosophy, and provide a brief description of clinical manifestations targeted by the EASE. We also present our personal experience using and teaching the EASE and summarize the empirical evidence obtained so far. We conclude that the basic self-disorder represents a crucial phenotype of schizophrenia spectrum disorders and that this phenotype offers a potential avenue to empirical pathogenetic research and psychotherapeutic treatment.
Obsessive-compulsive symptoms are frequent in schizophrenia-spectrum disorders and often cause di... more 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 differential diagnosis between obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders. The classic psychopathological literature defines true obsession as intrusions with intact resistance and insight and regards these features as essential to the diagnosis of OCD. In schizophrenia, the classic literature describes pseudo-obsessive-compulsive phenomena characterized by lack of resistance and an affinity with other symptoms such as thought disorder and catatonia. By contrast, the notions of obsession and compulsion are broader and conceptually vague in current diagnostic systems and research instruments. Here, these phenomena overlap with delusions as well as various subjective and behavioral anomalies, which we discuss in detail. Furthermore, we examine a link between obsessive-compulsive phenomena and disturbances of basic structures of experience in schizophrenia-spectrum disorders addressed in contemporary psychopathological research. We suggest that these experiential alterations have relevance for differential diagnosis and early detection in this complex symptom domain.
Here, we report the first systematic, empirical findings regarding
salient subjective experiences... more Here, we report the first systematic, empirical findings regarding salient subjective experiences termed anomalies of imagination. These disturbances can be assessed with the psychopathological instrument, Examination of Anomalous Imagination and Fantasy (EAFI), in a semi-structured interview. In a cross-sectional sample, we investigated their diagnostic distribution and correlations with dimensions of schizophrenia-spectrum psychopathology.
Background: Anomalies of imagination encompass disturbances of the basic experiential structure o... more 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 healthy controls, and (2) to examine their relation with disorders of basic self, perceptual disturbances and canonical state psychopathology of the schizophrenia-spectrum (positive, negative and general symptoms).
Methods: The 81 participants included patients with schizophrenia or other non-affective psychosis (N = 32), schizotypal personality disorder (N = 15) or other mental illness (N = 16) and healthy controls (N = 18). The assessment encompassed EAFI, Examination of Anomalous Self-Experience (EASE), parts of Bonn Scale for the Assessment of Basic Symptoms (BSABS) and Positive and Negative Syndrome Scale (PANSS). For network analysis, the associations of EAFI with the other psychopathological variables were tested by Pearson's correlation coefficient and graphically represented using multidimensional clustering. Comparisons between correlations in the network were tested with Steiger's test.
Results: Anomalies of imagination aggregated significantly in schizophrenia-spectrum disorders compared to other mental illness and healthy controls with no difference between schizophrenia and schizotypal disorder. In the network analysis, anomalies of imagination were closely inter-connected with self-disorders. Although, the anomalies of imagination correlated moderately with perceptual disturbance and positive, negative and general state symptomatology, these dimensions aggregated separately and relatively distant in the network.
Conclusions: The results support that anomalies of imagination are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders.
Background Imagination is the formation of ideas or images of something known not to be present t... more 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 rang...
European Archives of Psychiatry and Clinical Neuroscience, 2019
The differential diagnosis of obsessive-compulsive disorder (OCD) and schizophrenia-spectrum diso... more 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 such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession ('with resistance') and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clini-cian. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizo-phrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive-compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.
Abstract
The Examination of Anomalous Fantasy and Imagination
(EAFI) is an instrument for a semis... more Abstract 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 imagination explored by the EAFI reflect an alteration in the structure of consciousness and belong to a fundamental, generative layer of psychopathology with relevance to differential diagnostic purposes.
Abstract
This paper serves as an introduction to the Examination of
Anomalous Fantasy and Imagina... more Abstract 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 the EAFI. Furthermore, the interrater reliability of the EAFI was examined in a diagnostically heterogeneous sample of 20 in-patients. The interrater agreement ranged from 0.6 to 1.0, with an average κ of 0.84. The internal consistency of the EAFI as measured by Cronbach’s α was above 0.88. We suggest that the anomalies of imagination explored by the EAFI reflect an alteration of the structure of consciousness and belong to a fundamental, generative layer of psychopathology. These disorders may have relevance for differential diagnostic purposes, especially in first-contact, young patients.
Internal vivid imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenome... more Internal vivid imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenomena, like obsessions or ruminations are also frequent in other psychiatric disorders, raising significant diagnostic challenges. Unfortunately, contemporary psychiatry does not possess a sufficiently nuanced conceptual framework to address these important issues. After a brief historical discussion, we provide a novel, phenomenological account of anomalous imagination in the schizophrenia spectrum disorders. Drawing on illustrative patients’ self-descriptions, we report a perceptualized imagery, radically deviating from normal imagination. This account points to an eroded structure of the first-person perspective. The anomalous imagery acquires spatialization, spatio-temporal constancy, explorability, autonomy, and a sense of experiential distance between the subject and the imagined content. The sense of the irreality of the phantasy may become compromised. We propose that pathology of imagination is an important aspect of psychopathology in the schizophrenia spectrum, with a diagnostic relevance and a potential for systematic empirical studies.
Vivid mental imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenomena... more Vivid mental imagery occurs frequently in schizophrenia spectrum disorders. Overlapping phenomena, such as obsessions or ruminations, are also frequent in other psychiatric disorders, raising significant diagnostic challenges. Unfortunately, contemporary operational psychopathology lacks epistemological and phenomenological framework to address such questions. Using the resources of phenomenology and philosophy of mind, we articulate the structure of imagination and describe its distinctive modifications in the schizophrenia spectrum disorders. Drawing on the pilot data with patients’ self-descriptions, we present the notion of perceptualized imagery. The anomalous imagery acquires spatialization, spatio-temporal constancy, explorability, autonomy, and a sense of experiential distance between the subject and the image. As a quasi-perceptual, stable object, such imagery often evokes intense affective response whereas the normal sense of "irreality" of the phantasy may become compromised. We articulate these anomalies of imagination as being entailed by the underlying generative disorder of schizophrenia, namely the disorder of minimal self (unstable ipseity or first-person perspective). We propose that pathology of imagination is an important psychopathological aspect of the schizophrenia spectrum, with significant relevance for early diagnosis and differential diagnosis.
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salient subjective experiences termed anomalies of imagination. These disturbances can be assessed with the psychopathological instrument, Examination of Anomalous Imagination and Fantasy (EAFI), in a semi-structured interview. In a cross-sectional sample, we investigated their diagnostic distribution and correlations with dimensions of schizophrenia-spectrum psychopathology.
Methods: The 81 participants included patients with schizophrenia or other non-affective psychosis (N = 32), schizotypal personality disorder (N = 15) or other mental illness (N = 16) and healthy controls (N = 18). The assessment encompassed EAFI, Examination of Anomalous Self-Experience (EASE), parts of Bonn Scale for the Assessment of Basic Symptoms (BSABS) and Positive and Negative Syndrome Scale (PANSS). For network analysis, the associations of EAFI with the other psychopathological variables were tested by Pearson's correlation coefficient and graphically represented using multidimensional clustering. Comparisons between correlations in the network were tested with Steiger's test.
Results: Anomalies of imagination aggregated significantly in schizophrenia-spectrum disorders compared to other mental illness and healthy controls with no difference between schizophrenia and schizotypal disorder. In the network analysis, anomalies of imagination were closely inter-connected with self-disorders. Although, the anomalies of imagination correlated moderately with perceptual disturbance and positive, negative and general state symptomatology, these dimensions aggregated separately and relatively distant in the network.
Conclusions: The results support that anomalies of imagination are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders.
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 imagination explored by the EAFI reflect an alteration in
the structure of consciousness and belong to a fundamental,
generative layer of psychopathology with relevance to differential
diagnostic purposes.
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
the EAFI. Furthermore, the interrater reliability of the EAFI
was examined in a diagnostically heterogeneous sample of
20 in-patients. The interrater agreement ranged from 0.6 to
1.0, with an average κ of 0.84. The internal consistency of the
EAFI as measured by Cronbach’s α was above 0.88. We suggest
that the anomalies of imagination explored by the EAFI
reflect an alteration of the structure of consciousness and belong
to a fundamental, generative layer of psychopathology.
These disorders may have relevance for differential diagnostic
purposes, especially in first-contact, young patients.
salient subjective experiences termed anomalies of imagination. These disturbances can be assessed with the psychopathological instrument, Examination of Anomalous Imagination and Fantasy (EAFI), in a semi-structured interview. In a cross-sectional sample, we investigated their diagnostic distribution and correlations with dimensions of schizophrenia-spectrum psychopathology.
Methods: The 81 participants included patients with schizophrenia or other non-affective psychosis (N = 32), schizotypal personality disorder (N = 15) or other mental illness (N = 16) and healthy controls (N = 18). The assessment encompassed EAFI, Examination of Anomalous Self-Experience (EASE), parts of Bonn Scale for the Assessment of Basic Symptoms (BSABS) and Positive and Negative Syndrome Scale (PANSS). For network analysis, the associations of EAFI with the other psychopathological variables were tested by Pearson's correlation coefficient and graphically represented using multidimensional clustering. Comparisons between correlations in the network were tested with Steiger's test.
Results: Anomalies of imagination aggregated significantly in schizophrenia-spectrum disorders compared to other mental illness and healthy controls with no difference between schizophrenia and schizotypal disorder. In the network analysis, anomalies of imagination were closely inter-connected with self-disorders. Although, the anomalies of imagination correlated moderately with perceptual disturbance and positive, negative and general state symptomatology, these dimensions aggregated separately and relatively distant in the network.
Conclusions: The results support that anomalies of imagination are highly characteristic of schizophrenia-spectrum disorders and closely related to self-disorders.
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 imagination explored by the EAFI reflect an alteration in
the structure of consciousness and belong to a fundamental,
generative layer of psychopathology with relevance to differential
diagnostic purposes.
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
the EAFI. Furthermore, the interrater reliability of the EAFI
was examined in a diagnostically heterogeneous sample of
20 in-patients. The interrater agreement ranged from 0.6 to
1.0, with an average κ of 0.84. The internal consistency of the
EAFI as measured by Cronbach’s α was above 0.88. We suggest
that the anomalies of imagination explored by the EAFI
reflect an alteration of the structure of consciousness and belong
to a fundamental, generative layer of psychopathology.
These disorders may have relevance for differential diagnostic
purposes, especially in first-contact, young patients.