Borda 2015

SCHRES-06553; No of Pages 10
Schizophrenia Research xxx (2015) xxxxxx
Contents lists available at ScienceDirect
Schizophrenia Research
journal homepage: www.elsevier.com/locate/schres
Phenomenology and neurobiology of self disorder in schizophrenia:

Primary factors
Juan P. Borda a,1, Louis A. Sass ,b
a
b
Dept of Mental Health, Ponticia Universidad Javeriana, Bogot, Colombia

Rutgers University, Piscataway, N.J. 08854, U.S.A
a r t i c l e
i n f o
Article history:
Received 19 February 2015
Received in revised form 16 September 2015
Accepted 18 September 2015
Available online xxxx
Keywords:
Phenomenology
Schizophrenia
Self-disorder
Neurocognitive models
Philosophy
Psychosis
a b s t r a c t
Schizophrenia is a heterogeneous syndrome, varying between persons and over course of illness. In this and a
companion article, we argue that comprehension of this condition or set of conditions may require combining
a phenomenological perspective emphasizing disorders of basic-self experience (ipseity disturbance) with a
multidimensional appreciation of possible neurobiological correlatesboth primary and secondary. Previous
attempts to link phenomenology and neurobiology generally focus on a single neurocognitive factor. We consider
diverse aspects of schizophrenia in light of a diverse, albeit interacting, set of neurocognitive abnormalities,
examining both synchronic (structural) interdependence and diachronic (temporal) succession.
In this article we focus on the primary or foundational role of early perceptual and motoric disturbances that
affect perceptual organization and especially intermodal or multisensory perceptual integration (perceptual
dys-integration). These disturbances are discussed in terms of their implications for three interconnected
aspects of selfhood in schizophrenia, primary forms of: disrupted hold or grip on the world, hyperreexivity,
diminished self-presence (self-affection).
Disturbances of organization or integration imply forms of perceptual incoherence or diminished cognitive coordination. The effect is to disrupt one's ability to apprehend the world in holistic, vital, or contextually grounded
fashion, or to fully identify with or experience the unity of one's own body or thinkingthereby generating an
early and profound (albeit often subtle) disruption or diminishment of basic or core self and of the sense of
existing in a coherent world. We discuss interrelationships or possible complementarities between these three
aspects, and consider their relevance for a neurodevelopmental account of schizophrenia.
2015 Elsevier B.V. All rights reserved.
1. Introduction
Schizophrenia is a heterogeneous clinical syndrome, with signicant
psychopathological variation both between persons and within the
same individual at different moments of life or course of illness
(Silveira et al., 2012; Silverstein et al., 2014; Tandon, 2014; Tandon
et al., 2009). Current diagnostic classications approach this complex
phenomenon using syndromatic denitions based on presence or
absence of a restricted set of signs or symptoms, selected by expert consensus (Andreasen, 2007; De Leon, 2013; Kendler, 2009; Stanghellini,
2009b). Starting with DSM III, interrater reliability came to be highly
emphasized, with identication of operationalized signs and symptoms
tending to replace more complex but judgmental assessment of mental
or experiential life (Andreasen, 2007; De Leon, 2013; Kendler, 2009;
Markov and Berrios, 2009). Arguably, this has led to inclusion of
patients with divergent clinical symptomatology in the same diagnostic
Corresponding author at: Dept of Clinical Psychology, GSAPPRutgers, the State
University of New Jersey, 152 Frelinghuysen Road, Piscataway, New Jersey, 08854, USA.
E-mail address: lsass@rci.rutgers.edu (L.A. Sass).
1
The only contributors to this article are the two listed coauthors.
categories, thereby producing validity difculties that undermine both

research and treatment (Insel, 2009, 2010; Kendall, 2011; Naber and
Lambert, 2009; Parnas et al., 2013; Tandon, 2012; Tyrer and Kendall,
2009). Criticism of the schizophrenia diagnosis has a long history, yet
no viable alternative has arisen, perhaps suggesting some underlying
validity to this admittedly problematic diagnostic category.
Phenomenology is the study of lived experience, i.e., of the nature
and varieties of human subjectivity (Sass, 2010). Phenomenology can
complement the clinical panorama by offering a sophisticated way of
describing subjective dimensions of mental illnesses (Fuchs, 2010;
Sass, 2010; Sass et al., 2011). In this and a companion paper, we review
phenomenological descriptions of the schizophrenia syndrome while
considering a variety of possible neurobiological correlates. We believe
the best prospect for a valid comprehension of this enigmatic condition
or set of conditions will derive from combining two viewpoints: 1, a
phenomenological perspective that is sensitive to both the heterogeneity of schizophrenia and underlying commonalities; together with 2, a
multidimensional appreciation of possible neurobiological correlates
relevant to shared as well as divergent features of the illness, viewed
both synchronically and diachronically (that is, both cross-sectionally
and in terms of pathogenetic developments over time).
http://dx.doi.org/10.1016/j.schres.2015.09.024
0920-9964/ 2015 Elsevier B.V. All rights reserved.
Please cite this article as: Borda, J.P., Sass, L.A., Phenomenology and neurobiology of self disorder in schizophrenia: Primary factors, Schizophr. Res.
(2015), http://dx.doi.org/10.1016/j.schres.2015.09.024
J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx
The crucial role of adequate recognition of mental or psychological symptoms has been emphasized by various authors (Andreasen,
2007; Parnas et al., 2013). Markov and Berrios (2009) note that
mental symptoms play a more important epistemological role in psychiatry than medical symptoms in medicine, where the latter are
being gradually replaced by biological markers (Markov and
Berrios, 2009; Nordgaard et al., 2013; Parnas et al., 2013). These authors
stress the need to generate a psychiatric epistemology capable of
addressing both structural (synchronic) and temporal (diachronic)
relations within or between mental phenomena in clinical syndromes
(Markov and Berrios, 2012). Sass (2010, 2014) has argued that phenomenology, in particular, can help generate explanatory hypotheses
relevant to several types of both the (diachronic) temporal unfolding
of symptoms and the (synchronic) complementary relationships
existing between distinct aspects of abnormal experience at a single
phase or point in time.
Various empirical studies demonstrate association between subjective abnormalities and neurobiological dysfunction in diverse
mental syndromes or diseases, supporting subjective experience as
an object of study in biological psychiatry and neuroscience (Lutz and
Thompson, 2003; Sass et al., 2011; Varela, 1996). There are a number
of previous attempts to link phenomenology and neurobiology/
neurocognition in schizophrenia (Fletcher and Frith, 2008; Nelson
et al., 2014a, 2014b; Postmes et al., 2014; Sass, 1992; Taylor, 2011;
Uhlhaas and Mishara, 2007). Whereas most previous attempts have
focused on a single underlying neurobiological dysfunction, in these articles we consider diverse aspects of schizophrenia-related symptomatology in light of a diverse, albeit interconnected, set of neurobiological and
neurocognitive abnormalities, and in terms of both synchronic
(structural) interdependence and diachronic (temporal) succession
over time. We will consider both the synchronic and diachronic
dimensions in relation to the inuential neurodevelopmental model of
schizophrenia. In this model, noxious factors interfere with normal
maturational brain processes during early stages of development,
generating during childhood and adolescence neurologic (and concomitant subjective) abnormalities that at some point nally eventuate in the full-blown clinical syndrome (Gogtay et al., 2004; Insel,
2010; Parnas et al., 1996; Piper et al., 2012; Rapoport et al., 1999;
Thompson and Levitt, 2010).
2. General considerations
Dysfunction, disruption, or dissociation of the self has long been recognized as a central psychopathological feature of schizophrenia (Sass,
2001). In contemporary psychiatry, the most prominent, phenomenologically oriented account of schizophrenia identies the primary disturbance as a disruption of core or minimal self, also known as ipseity
(Sass and Parnas, 2003; Sass, 2014; Nelson et al., 2014a, 2014b). The
term self is highly ambiguous. Here we refer not to issues of social
identity or autobiographical self-awareness, but to the most basic
sense of selfhood or self-presence: a crucial sense of self-sameness, a
fundamental sense of existing as a vital and self-identical subject of
experience or agent of action (Sass and Parnas, 2003; Sass, 2014).
The model of an altered core or minimal self in schizophrenia has

received considerable evidential support in the last decade or more. A
meta-analysis by Hur et al. (2013), which combines 25 publications
(690 patients with schizophrenia compared to 979 healthy controls),
corroborates empirically a disturbance in minimal self as a core feature
of this syndrome. Moreover, the phenomenological model of selfdisorder in schizophrenia has been operationalized and validated in
numerous studies using the EASE (Examination of Anomalous SelfExperience) (Haug et al., 2014; Nordgaard and Parnas, 2014; Parnas
et al., 2014; Parnas and Henriksen, 2014). This instrumenta qualitative, semi-structured interview formathas demonstrated adequate
psychometric properties including high internal consistency (Mller
et al., 2011; Nordgaard and Parnas, 2014) and good-to-excellent
interrater reliability with trained clinicians (Mller et al., 2011; Parnas
et al., 2005).
The foundational disorder of core self or ipseity is understood from a
phenomenological standpoint as having three interrelated aspects that,
taken together, can account for all the major symptoms of schizophrenia
(Sass and Parnas, 2003; Sass, 2007; Sass, 2003). The three aspects are:
1, Hyperreexivitywhich refers to an exaggerated self-consciousness,
a tendency (fundamentally non-volitional) for focal attention to be
directed toward processes and phenomena that would normally be
inhabited or experienced (tacitly) as part of oneself, but now
come to be experienced as having an alien quality (Sass, 1992; Sass
et al., 2011).
2, Diminished self-presence (or diminished self-affection)which refers
to a decline in the (passively or automatically) experienced sense
of existing as a subject of awareness or agent of action. (The term
affection refers not to liking, but to a process of being affected by
something (Sass, 2014; Sass et al., 2011)).
3, Disturbed grip or hold on the cognitive-perceptual worldwhich
refers to disturbances of spatio-temporal structuring of the world,
and of the clarity of such crucial experiential distinctions as
perceived-vs-remembered-vs-imagined. (These seem to be
grounded in abnormalities of the embodied, vital, experiencing
self, which normally serves as a kind of constituting and orienting
background for experience of the world (Gallagher, 2005; Sass,
2004, 2014; Sass and Parnas, 2003).)
These are largely descriptive concepts. When viewed in a pathogenetic context, each of these aspects can, however, also be understood
in a more differentiated manner, with some manifestations or processes
hypothesized to have a more primary or foundational, and others a
more secondary though also crucial role in the development of schizophrenia. Whereas this article discusses the primary factors, a subsequent one will consider secondary factors that are typically generated
by the more foundational ones, and with which they come to be intimately intertwined. See Table 1. (The primary-vs-secondary distinction
is, of course, a heuristic simplication: there are not just two but many
possible variants.)
In several models of normal psychological development (Piaget and
Inhelder, 1969; Postmes et al., 2014; Stern, 2000; Rochat, 2009), sensory
and motor functions are hypothesized to play a crucial role in early
Table 1
Types of ipseity disturbance.
Phenomenological
Abnormality
Neurocognitive factors
Primary factors
Primary disturbed grip

Operative (or primary) hyperreexivity
Primary diminished self-presence (a.k.a. diminished self-affection)
Grounded in disturbed perceptual organization and integration, especially

disturbed intermodal integration including motoric, proprioceptive,
kinesthetic processes (perceptual dys-integration)
Secondary factors
Reective (or secondary) Hyperreexivity (a.k.a. hyper-reectivity)

Secondary diminished self-presence (a.k.a. diminished self-affection)
Secondary disturbed grip
Hypoactivity of Central Executive Network, and hyperactivity of

Default-Mode Network (DMN), both associated with dysregulation of
Salience Network
Ipseity = core, minimal, or basic self-experience.
consolidation of the nuclear or basic self. This is consistent with the tendency, in contemporary cognitive science as well as phenomenological
theory, to recognize the interdependence of action and perception
and, in particular, the role of the lived-body or body schema in the
constitution of experience in general (Gallagher, 2000; Gallese and
Sinigaglia, 2010, 2011; Merleau-Ponty, 2012; No, 2004). It is noteworthy that several studies have found childhood motor, perceptual, and
cognitive abnormalities in persons who later develop schizophrenia
(Erlenmeyer-Kimling et al., 2000; Fis et al., 2008; Schenkel and
Silverstein, 2004; Srensen et al., 2010), and that disturbed integration
of perceptual and motoric functions are prominent among these early
abnormalities (Gamma et al., 2014). Oddly, however, with some exceptions, little explicit association has been made between these biological
alterations and possible problems in constituting, in particular, the
nuclear or basic self, or in describing its specic repercussions in
schizophrenia patients.
One important exception is a path-breaking article by Parnas et al.
(1996). These authors hypothesized put forth the hypothesis that impaired intramodal and intermodal binding capacities, especially involving intertwining of motility and perception, may underlie the profound
alterations of self-experience and intersubjectivity and the instability
of major modalities of consciousness characteristic of schizophrenia
(Parnas et al., 1996, p. 185186). A recent article by Postmes et al.
(2014) offers a similar perspective. These authors generate a variety of interesting hypotheses regarding how difculties in perceptual integration
and its sequelae could give rise to various aspects of schizophreniarelated self-disturbance. We adopt a similar viewpoint in this article and
its companion. Our hope, however, is to present a pathogenetic model
that is, at least in certain respects, more specic and more encompassing.
Abnormalities of perceptual integrationwhat we shall term perceptual
dys-integrationare not unique to schizophrenia-spectrum disorders
(Kjaersdam Tellus et al., 2015; Shin et al., 2008; Uhlhaas et al., 2008).
They exist on a continuum, occurring in individuals outside the schizophrenia spectrum in milder form (Feigenson et al., 2014); They do however seem likely to play a signicant pathogenetic role in these
spectrum conditions.
Only a few studies in recent decades have explored associations
between schizophrenia-like disturbances of core-self experience
and neuropsychological factors, mostly using traditional measure of
neurocognitive dysfunction and nding mixed results. Although
Cuesta et al. (1996) reported close relationship with several cognitive abnormalities, Haug et al. (2012) found only associations with
verbal memory. Schultze-Lutter et al. (2007) showed a relation between affective-dynamic disturbances in the Schizophrenia Proneness
Instrument with neurocognitive function, but no relation with subjectively experienced cognitive and perceptive performance in the same
scale. Zanello and Huguelet (2001) did not nd association between
core-self abnormalities and frontal cognitive functions; importantly,
Nordgaard et al. (2015) found no correlation between ipseity disturbance as measured by EASE and neurocognitive functioning. Sample
sizes were small; and only two studies (Haug et al., 2012; Nordgaard
et al. 2015) assessed core-self abnormalities using the EASE (the others
used the more tangentially related Basic Symptoms scales). Also, these
studies used predominantly executive tests, which measure prefrontal
functions, setting aside affective- and somato-sensory processes central
in the core-self model.
The results suggest that self disturbance may well be rather independent of traditionally dened neurocognitive disorders, and probably
captures a distinct dimension of psychological life. We argue that self
disturbance is more related to the perceptual dys-integration and secondary sequelae discussed here and in our companion article.
In this rst article we propose to consider the three aspects of
disturbed ipseity that seem likely to play a primary or foundational
role in the development of schizophrenia, viewing each aspect in
relation to the hypothesis of disturbed perceptual integration, especially
intermodal integration (see Table 1), and considering the
interrelationships or interdependency between the aspects. The phenomenological abnormalities discussed here seem 1) to appear early
in the life-course of persons who eventually develop schizophrenia,
2) to be experienced in a largely automatic and pre-reective (termed
operative (Merleau-Ponty, 2012, p. lxxxii)) form by the patient, and
3) to indicate basic pathological alterations present long before developing a full-blown syndrome. In a second article, we will review the
phenomenological disturbances and possible neurobiological abnormalities that seem likely to play compensatory or consequential roles
as sequelae that follow upon and interact with (often starting from a
very early stage) the more pathogenetically primary abnormalities described here. In this way we hope to offer a comprehensive account.
This combination of foundational together with secondary factors, understood neuro-phenomenologically, can help to clarify and perhaps explain both the divergent and the common or unifying features of
schizophrenia's symptomatic presentation. It is plausible, for instance,
that the primary factors associated with perceptual dys-integration
might play a more dominant role in so-called poor premorbid patients,
and also in the negative and disorganized symptoms; whereas secondary
factors may be more prominent in good premorbid patients, and in positive symptoms of a dissociative or paranoid kind (see article 2). The common features would be inherent in the shared presence of ipseity or coreself disturbance of one kind or another, with at least some involvement of
primary forms grounded in perceptual dys-integration.
Now we shall consider, one by one, the three primary aspects of
schizophrenia postulated by the ipseity-disturbance hypothesis. As
mentioned, these aspects seem to be complementary and perhaps
equally basic from a pathogenetic standpoint; as we shall see, they are
highly overlapping (hardly surprising, given the acknowledged holism
or inextricable interdependence of mental life (Husserl, 1977; James,
1950)). We begin (somewhat arbitrarily) with the aspect whose relation to perceptual integration has been studied most extensively.
3. Disturbed grip or hold on the world
Some noteworthy features of schizophrenia are fragmentation of
global or gestalt perception, decits in context processing, and abnormal discrimination between familiar and strange stimuli (Martin and
Pacherie, 2013; Sass, 2004). The phenomenological concept of disturbed
grip or hold on the world (Sass and Parnas, 2003) means to encompass these experiential disturbances in the coherence, focus, stability,
and framing of the eld of consciousness (Sass, 2004)including, as
noted, disturbances of spatiotemporal structuring and clear distinction
of perceived-vs-remembered-vs-imagined (all assumed to constitute
the world-aspect or world-correlate of disrupted self-experience).
Alterations in perceptual organization or perceptual integration
(Martin and Pacherie, 2013; Postmes et al., 2014; Uhlhaas and
Silverstein, 2005) have long been recognized as a key feature of
schizophrenia. Perceptual organization is dened as the ability of
perceptual systems to organize sensory information into coherent
representations that can serve as the basis of our experience of and
action in the world (Palmer and Nelson, 2000). Impaired perceptual
organization has been viewed as the joint product of: A) decient
bottom-up linking of basic features, and B) reduced top-down feedback associated with reduced ability to impose structure on fragmented
stimuli (Silverstein and Keane, 2011; Uhlhaas and Silverstein, 2005).
The phrase perceptual organization has been applied primarily
to visual perception, but often with acknowledgement of the contributing role of other modalities (Silverstein and Keane, 2011).
Perceptual integration, as generally used, explicitly emphasizes
intermodal synthesizing, including of visual and auditory with
proprioceptive/kinesthetic modalitiesthat is, of exteroceptive with
interoceptive modalities (the latter involving sensitivity to stimuli originating inside the body). In practice, the notions of perceptual organization and perceptual integration can be quite overlapping (see,
eg., Postmes et al., 2014).
Disturbances of both perceptual organization and integration have,

in any case, been widely conrmed in empirical studies of patients
with schizophrenia, supporting the phenomenological descriptions
mentioned above. At least three comprehensive reviews support this
view. Uhlhaas and Silverstein report that 28 of 33 studies published
until 2004 found impairments of perceptual organization in schizophrenia patients (Uhlhaas and Silverstein, 2005). In another review of studies from 2005 to 2010, such perceptual-organization deciencies were
reported in 26 of 27 publications (Silverstein and Keane, 2011); such
disturbance was relatively specic to schizophrenia, not characteristic
of bipolar or other psychotic (or nonpsychotic) disorder, nor of
pervasive developmental disorders including autism (p. 695). Silverstein
and Keane suggest (referencing Phillips and Silverstein, 2003) that
perceptual-organization difculties are but one manifestation of a
widespread impairment in cognitive coordinationthe grouping of
information based on contextual relationships (p. 696). Finally, Postmes
et al. report on 69 publications that show abnormal multisensory
integration in schizophrenia spectrum disorders, then argue that
such alterationwhat they term perceptual incoherenceis a key
etiopathological factor in the phenomenological disruption of coreself described in this syndrome (Postmes et al., 2014). The intermodal
or multisensory forms of perception they emphasize typically involve
interoceptive processes (including the vestibular sense), often in coordination with exteroceptive perception of the world.
Some experts propose defective perceptual organization as a
general way of conceptualizing the neurocognitive abnormality associated with decient binding of object information with context information (Phillips and Silverstein, 2003; Silverstein and Keane, 2011).
In accord with this hypothesis, Talamini has shown how, in schizophrenia, mediotemporal lobe abnormalities seem to be associated with
erroneous binding of contextual temporo-spatial information with
object-specic information during formation of single episodic representations (Talamini et al., 2010; Talamini and Meeter, 2009). This results in over-representation of the object at the expense of contextual
informationan abnormality that could account, in turn, for decient
episodic memory, severe context insensitivity, abnormalities in train
of thought, and contextually inappropriate behavior in these patients
(Talamini et al., 2010; Talamini and Meeter, 2009). Such a disturbance
of context-awareness obviously implies an undermining of the patient's
grip or hold on both spatiotemporal framework and orienting modality
(perceived/remembered/imagined).
It is noteworthy that schizophrenia patients show alteration in
proprioceptive/kinesthetic perception as well as in the visual and auditory modalities mentioned above (Postmes et al., 2014)given that
abnormalities incorporating the former modalities seem particularly
likely to affect basic-self experience. Various authors have highlighted
the importance of continuous interoceptive feedback, noting that such
self-related afference provides the background for virtually all experience by grounding the perceiver's sense of spatial orientation, temporal
continuity, and general presence in the world (Damasio, 2010; Fuchs,
2010; Lallart et al., 2009; Postmes et al., 2014; Stanghellini, 2009a).
Interoception is in fact continuously linked in working memory with
representations of the exterior world, thereby generating Minimal Perceptual Unities that support the subjective sense of reality as a unique,
oriented, global, and relevant experience (Damasio, 2010). Such a
view is consistent, incidentally, with the current emphasis in cognitive
science on the embodied and action-grounded nature of human experience and knowing (Gallese and Sinigaglia, 2010, 2011; O'Regan and
No, 2001)that is, with the role of the body/self or lived-body in determining our experience of the affordance-qualities of the world (its relevance for our purposes and projects).
Although a recent publication by Feigenson et al. (2014) raises the
possibility that perceptual disorganization might be a modifying inuence mechanism rather than an illness-specic core impairment, since
it seems to exist in milder form on a continuum across the general population, there are several studies supporting the hypothesis that
disturbed perceptual integration (perceptual dys-integration) is related

to trait as well as state aspects in schizophrenia. Indeed, abnormal perceptual integration of both object- and body-related experience can be
demonstrated in 8-month-old infants of parents with schizophrenia
(n = 58), when compared with infants of healthy parents or parents
with affective or other types of psychosis (Gamma et al., 2014), thereby
suggesting the early presence and high heritability of perceptualintegration decit. Disturbances of perceptual integration are consistent
with the presence of basic symptomsthe subtle but persistent disruptions of perceptual, motoric, affective, and cognitive life found in
persons prone to schizophrenia, and which can be interpreted as involving subtle disturbances of self-experience (Schultze-Lutter, 2009). Also,
several publications associate impaired perceptual organization in
schizophrenia patients with level of disorganized symptoms, poor
premorbid functioning, need for inpatient treatment, and pharmacological response (Uhlhaas and Silverstein, 2005; Knight and Silverstein,
1998; Uhlhaas, et al. 2005), thus indicating some covariance between
this impairment and more severe forms of illness.
It seems that, in addition to an equilibrium between object and
context in the external world, an equilibrium between external and
internal sensory stimuli (and thus necessarily intermodal) is also
necessary for grounding a stable, unied, and oriented experience of
reality. Alteration in perceptual integration may therefore offer a
neurocognitive account that is relevant to several characteristic (and
probably interrelated) areas of difculty in schizophrenia: A) using
context to guide perception of the external world, B) generating a
holistic perception of reality with clear and stable gestalt structure,
and C) forging a coherent sense of personal bodily presence. All three
seem relevant to achieving normal grip or hold on the external
world. To the extent that minimal or basic self is a correlate of a coherent
and meaningful world (with self and world mutually constituting of each
other), disturbances of ipseity are implicated in these abnormalities.
4. Operative hyperreflexivity
We use the phrase operative hyperreexivity to refer to the automatic (as opposed to actively brought about (Merleau-Ponty, 2012, p.
lxxxii) emerging-into-awareness or popping-out of phenomena that
would normally remain in the tacit background, but now come to be
experienced in an objectied and alienated manner. These processes,
which are experienced more as afiction than as act (Sass, 1992,
2014), can be distinguished from the more defensive, sometimes even
deliberate forms of reective or secondary hyperreexivity to be treated
in our second article. Frequently the phenomena that pop-out in operative hyperreexivity involve proprioceptive, kinesthetic, or other interoceptive body sensations that would normally be experienced only
in a tacit or background manner.
Theoretical descriptions of normal basic or implicit sense of bodyawareness (which is pre-reective) propose the existence of two different aspects: the sense of the body as mine (body ownership) and that of
being the author of bodily movement (body agency) (Berlucchi and
Aglioti, 1997; S Schwabe and Blanke, 2007; Synofzik et al., 2008; Tsakiris
et al., 2007; Van den Bos and Jeannerod, 2002). Although sense-ofagency normally implies ownership (one knows one is controlling
one's own body), ownership may not necessarily imply sense-ofagency (one's own body can be moved by another). Not surprisingly,
evidence indicates that body ownership is more related to the integrative perception of afference, while sense of agency is more related
to motor efference and associated feedback processes responsible for
generating actions (S Schwabe and Blanke, 2007; Synofzik et al., 2008;
Tsakiris, 2010; Tsakiris et al., 2007). In reality, however, afferent and
efferent processes, like ownership and agency, generally exist in
forms of intimate interaction or interdependence.
Both functions (body ownership and agency) are, in any case, closely
related to the concept of perceptual intermodal integration previously
discussed: a subject's ability to recognize and differentiate himself
from others requires both the triangulation inherent in coordinating perceptual inputs from various senses and the continuous comparison of these sensory inputs with subsequent modication of
internal models of the body or body/self-in-action (Gamma et al.,
2014; Jeannerod, 2003; Parnas et al., 1996; S Schwabe and Blanke,
2007; Tsakiris et al., 2007; Tsakiris, 2010; Van den Bos and Jeannerod,
2002; Wylie and Tregellas, 2010). As already noted, disturbed binding
perceptual capacities (involving intramodal as well as intermodal
integration) have been seen as a key precursor to schizophrenia
(e.g., (Parnas et al., 1996; Postmes et al., 2014; Gamma et al., 2014;
Uhlhaas and Silverstein, 2005)). Here we emphasize disturbed
intermodal integration or binding involving proprioceptive and
kinesthetic factors, thus highlighting the relevance of such perceptual dys-integration or incoherence for abnormal body ownership and
agency and in particular for operative hyperreexivity.
Extensive evidence in a recent meta-analysis by Hur and colleagues
indicate that schizophrenia patients experience alterations of both body
ownership and agency (Hur et al., 2013). Diminished body ownership
has been previously shown in schizophrenia patients through abnormal
performance in the Rubber Hand Illusion (RHI) paradigm (Thakkar
et al., 2011). Such patients also seem to focus, in alienated fashion, on
internal body processes or sensations that would normally remain in
the background of awareness (Martin and Pacherie (2013)). This
weaker sense of body ownershipwhich can be described as a form of
disrupted self-monitoringhas been explained by a combination of
conicting signaling in bottom-up multisensory integration and of difculties in top-down regulation of this perceptual afference (Thakkar
et al., 2011; Tsakiris, 2010), both processes related to disordered
perceptual integration. Moreover, neural mechanisms of normal body
ownership implicate primarily right temporoparietal junction (TPJ)
and inferior parietal lobe (Ehrsson et al., 2005; Tsakiris et al., 2008),
and these two brain areas do show abnormal functioning in schizophrenia (Arzy et al., 2007; Torrey, 2007).
Another disturbance of self-monitoring, abnormal sense of agency,
has also been repeatedly demonstrated in schizophrenia, as already
noted. Normally, agency is experienced when predicted sensory
consequences of motor commands correspond to actual sensory
input resulting from performing the action. Accordingly, misattribution
of agency in schizophrenia patients has been explained by deviation
between the predicted and perceived sensory consequences of physical
or mental actions, with a subsequent difculty in attributing sensory
changes correctly to one's own actions (Ferri et al., 2012; Frith et al.,
1998; Miele et al., 2011; Synofzik et al., 2010).
In healthy subjects, the temperoparietal junction (TPJ) area is activated when action consequences are not in line with intentions or
expectations (Miele et al., 2011). It has been shown (in research on
motor planning in monkeys) that the posterior parietal cortex (PPC)
uses multisensory integration including efference copies of motor commands to generate a prediction of the perceptual consequences of selfinitiated actions (Mulliken et al., 2008). It is noteworthy that these
two brain areas (TPJ and PPC), both implicated in sense of agency, are
also closely related to the generation of a sense of body ownership. In
fact, temperoparietal junction (TPJ) and posterior parietal lobe (including PPC), together with somatosensory cortex and the insula, are
believed to play the crucial role in the integration of proprioceptive/
kinesthetic sensations necessary for building neuronal representations
of a bodily self (Berlucchi and Aglioti, 1997; Jeannerod, 2003; S Schwabe
and Blanke, 2007; Tsakiris, 2010; Wylie and Tregellas, 2010). With
failure of such integration, such self-related sensations would not of
course simply disappear, but will likely emerge in a more fragmentary
and salient, thus alien fashion. There is considerable evidence of
functional and structural abnormalities in these brain areas in patients
with schizophrenia (Arzy et al., 2007; Ellison-Wright et al., 2008;
Glahn et al., 2008; Honea et al., 2005; Wylie and Tregellas, 2010).
There seems, then, to be good neuroanatomical support for the suggestion (not surprising, from a phenomenological or functional standpoint)
that an adequate sense of body ownership and limits (mine-vs-notmine) is closely linked with a normal sense of agency.
In addition to its obvious relevance for distinguishing self from
externally generated stimuli, and for grounding one's sense of
agency, another important (and closely related) function of these selfmonitoring processes is to keep habitual interoceptive sensorial
afferences in the background of awareness, in order that attentional
resources may target external aspects of experience that are likely to
be novel and to require focal attending (Blakemore et al., 1998; Voss
et al., 2010). It is important to realize that a normal sense of body ownership and agency actually requires at least partial absence of consciousness, or at least of focal attention. After all, individuals are normally
aware (indeed, they need to be aware) of their acting body almost
exclusively in an implicit fashion; only thus can experience retain its
normal spontaneity and ow, grounded in the lived-body or bodyschema but outer-directed. A turning of focal attention to bodily sensations or patterns of feeling is likely to transform these into something
akin to external objects (Giummarra et al., 2008; Gurwitsch, 1985;
Tsakiris et al., 2007), thus disrupting core self-experience by undermining
the normal sense of being-at-one-with or inhabiting one's lived-body
(Sass, 1992, chap. 7).
Similar self-alienation can occur in the realm of thought: when the
schizophrenia patient nds herself attending too focally to what
would normally be, not the object, but the transparent medium of
her thinking, e.g., inner speechwhich may be experienced in a quasihallucinatory fashion (Allen et al., 2007; Sass, 1992 chap 7). It is interesting, in this light, that Frith has described the specic kind of
attentional disturbance in schizophrenia as involving excessive selfawareness, often involving heightened awareness of the cognitive
unconsciousclearly a kind of hyperreexivity, which he describes as
occurring in a largely operative or passive fashion (Frith 1979).
As noted, Martin and Pacherie (2013) directly associate disturbed
body ownership and agency in schizophrenia with what we would
term operative hyperreexivity, namely, intrusive experiences of
common proprioceptive stimuli or thoughts that would normally
remain in the background (see also Sass, 1992 chap 7). Such persistent
and intrusive eruption into focal awareness of body perceptions (also of
normally transparent cognitive processes), likely to be felt more as
afiction than as act, will alter the balance between what are felt to be
internal versus external perceptual features of the Minimal Perceptual
Unities discussed above. Since internal sensations are now felt to
have at least a quasi-external quality, this will disrupt the person's
sense of self together with his grip or hold on the stability and general
status of the world, including its internal-vs-external or illusory-vs-real
qualities.
We see, then, that these two phenomenological
abnormalitiesdisturbed grip on the world and operative
hyperreexivitycan be understood as interacting and perhaps complementary (synchronic) manifestations of what may be a unitary
neurocognitive process (Sass, 2014): namely, a disruption of perceptual
integration that interferes with our experience of both world and basic
self.
5. Primary diminished self-presence
The third foundational aspect of ipseity disturbance is primary
diminished self-presence (a.k.a. diminished self-affection), which in its
more basic form refers to a (passive or automatic) decline in the experienced sense of existing or being present as a living and unied subject of
awareness or agent of action (Sass, 2014; Sass et al., 2011) (More defensive or secondary forms of diminished self-presence are treated in article two.) Diminished self-presence is, in fact, practically synonymous
with diminished sense of ownership and agency in everyday experiences and actions. In its primary form, it is, in a sense, the other side
of the coin of operative hyperreexivity, whose relationship to perceptual dys-integration was just discussed.
As we noted, the normal sense of agency inherent in performing an

action implies continuous neural communication between afferent and
efferent information (S Schwabe and Blanke, 2007; Synofzik et al.,
2008; Tsakiris, 2010; Tsakiris et al., 2007). In addition, it has been
demonstrated that adequate sense of agency can only develop
when action-effect associations (the link between motoric actions and
the perceived changes they bring about in the environment) are reliably
learned and ready for use by the motor system (Emanuel, et al., 2008;
Synofzik et al., 2008). Intact perceptual intermodal integration (involving both interoceptive and exteroceptive perceptions) is thus a prerequisite for generating a normal sense of body agency, which in turn
enables a person to experience subjective involvement in practical
tasks of everyday life and the sense of existingof self-presencethat
this implies.
Various authors have described how a basic sense of presence is at
least partially rooted in a normal experience of agency as well as in the
(closely related) ability to distinguish self from others (Herrera et al.,
2006; Lallart et al., 2009; Riva et al., 2004; Zahorik and Jenison,
1998)which also depends upon intermodal perceptual integration.
One interesting study, using a sensorimotor test involving the body, documented a close link between disturbed grip, decient sense of agency,
and diminished self-presence in schizophrenia patients: It was found
that disrupted perception-action coupling (a manifestation of disturbed
intermodal integration), with subsequent alteration of body agency, reduced the lived-body's role as an egocentric referent in these patients;
this implies diminishment of the patient's implicit sense of her own
presence, both to herself and as a point of orientation that centers
and thereby organizes the visuospatial eld (Lallart et al., 2009).
Diminished self-presence is most obvious in schizophrenia in the
form of rst-rank symptoms, including control delusions and experiences of thought-insertion and thought-alienationin which the
patient may lose the sense even of inhabiting his or her own actions
or thinking (Arzy et al., 2007; Danckert et al., 2004; de Vignemont
et al., 2006; Frith et al., 2000; Frith, 2005; Tsakiris et al., 2007; Wylie
and Tregellas, 2010). But primary diminished self-presence seems likely
to be related to negative symptoms as well, since it is obvious that a
weakened sense of existing as a living and unied subject, capable of
feeling connected to and affected by the changing but orienting
affordances of reality, could also underlie experiences of apathy, affective
attening, and disengagement from tasks of daily living (Sass, 2003).
We would emphasize the close connection between operative
hyperreexivity and primary diminished self-presence in patients
with schizophrenia. Whereas hyperreexivity emphasizes that something normally tacit becomes focal and explicit, diminished selfpresence emphasizes what may well be a complementary aspect of
this very same process: the fact that what once was tacitly experienced
(the lived body, e.g.) can no longer be inhabited as a medium of takenfor-granted selfhood (Sass, 2003, 170; Sass, 2010). In this sense these
phenomenological alterations could, in their primary or foundational
forms, be understood as constituting two intimately related aspects of
early developmental difculties affecting body ownership and agency.
Both would, in turn, be tightly linked with the disturbed grip that is
the worldly aspect or correlate of disturbed ipseity. Normally, we are
self-aware through our absorption in worldly objects; and aware of objects through our sense of being-there as a bodily subject. The subject
and the object, writes the phenomenological philosopher MerleauPonty (2012, p. 454), are two abstract moments of a unique structure,
namely, presence.
6. Neurodevelopmental considerations
A neurodevelopmental model of schizophrenia has been prominent in the last three decades. In this model (as mentioned above),
noxious factors disrupt normal brain maturation early in life, generating neurocognitive and experiential anomalies that appear during
childhood and adolescence and eventually lead to psychosis (Gogtay
et al., 2004; Insel, 2010; Parnas et al., 1996; Piper et al., 2012; Rapoport
et al., 1999; Thompson and Levitt, 2010). Three kinds of evidence support this hypothesis: A) evidence indicating that such early noxious
events as maternal malnutrition, infections in the second trimester of
pregnancy, and perinatal injury increase risk for schizophrenia (Brown
and Derkits, 2010; Cannon et al., 2002; Jones, 1994; Clair et al., 2005);
B) studies demonstrating that adults with schizophrenia showed
delayed acquisition of developmental milestones in infancy and
early childhood (Schenkel and Silverstein, 2004; Srensen et al.,
2010); and C) longitudinal observations of structural and functional
abnormalities early in the life of persons who later develop schizophrenia (Bhojraj et al., 2009, 2011; Li et al., 2012). Although the relevance of
these biological alterations for abnormal self-experience in schizophrenia have been noted (Brent et al., 2014), there has been little attempt to
articulate the implications these abnormalities would have for the constitution of abnormal ipseity or basic self.
Developmental studies in healthy subjects provide evidence that
selfrecognition, involving the sense of body ownership and agency,
normally appears as early as 5 months of age (Jeannerod, 2003;
Synofzik et al., 2008; Van den Bos and Jeannerod, 2002). This implicit
sense of self and spontaneous ability to discriminate self from others
appears to emerge earlier than any capacity for explicit self-recognition
(Ferri et al., 2012). Moreover, Ferri et al. (2012) postulate that infants
build an implicit awareness of the bodily or corporeal self through adequate articulation and integration of perceptual and motoric functions,
and that this pre-reective and pre-verbal sense of bodily selfhood provides the developmental basis for more mature psychological self.
The capacity to link proprioception/kinesthesia with external perceptive inputs across modalities (intermodal integration) is recognized
as a general prerequisite for early development of various abilities
including perceptual, motor, cognitive, phonetic, and intersubjective
(Parnas et al., 1996). The neural circuitry of perceptual integration
might in fact constitute much of the fundamental neural basis of basic
self-experience and the capacity to differentiate self from other (Brent
et al., 2014). Disruption of this circuitry may be related to the disturbed
connectivity of various brain networks, which is certainly characteristic of schizophrenia. Such dysconnectivity may involve abnormalities in
medial/lateral prefrontal cortex, or perhaps the insular cortex,
whichinterestingly enoughresides in a ssure between the temporal
lobe and the parietal and frontal lobes, and plays a role in integrating interoceptive and exteroceptive perceptual processes, in salience regulation, as well as in vital emotions and desires that affect the lived body
as a wholeall highly relevant to basic self (Brent et al., 2014, p. 76;
Manoliu et al., 2013, 2014, see Sass, in press Appendix on neurobiology).
As highlighted before, there is extensive evidence that indicates the
existence during infancy of motor, perceptual, and cognitive abnormalities in persons who later develop schizophrenia (Erlenmeyer-Kimling
et al., 2000; Fis et al., 2008; Schenkel and Silverstein, 2004; Srensen
et al., 2010), with abnormal perceptual and motoric functions prominent among these early abnormalities (Gamma et al., 2014).
Developmental psychology also supports the hypothesis that, in
healthy subjects, adequate integration of proprioception mediates
our understanding of other persons via processes of body-to-body
attunement (Stern, 2000). Disturbance of such integration would
clearly disrupt one's ability to relate to others (Merleau-Ponty, 2012;
Stanghellini, 2009a). It is noteworthy that current developmental theories view intersubjectivity as an essential facet of normal development
that affects our experience not only of other persons, but of the world
in general (since the perceptual eld is intersubjectively grounded
and dened). This implies that intersubjective disruptionitself
grounded in disturbance of the lived bodywould have important ramications affecting our grip on experience in general.
A crucial failure of pre-reective and pre-verbal forms of selfawareness seems, then, to be implied by early perceptual dys-integration.
(We have described altered body ownership and agency, and a livedbody that cannot serve as an organizing egocentric referent centering
the perceptual eld.) Several authors have hypothesized that this crucial
failure is compensated for via recruitment of different cognitive abilities,
including redirection of focal attention to previously unnoticed bodily
sensations, conscious monitoring of routine actions, and reliance on visual
information over proprioceptive afferences to determine agency or
ownership (Ferri et al., 2012; Lallart et al., 2009; Synofzik et al., 2010).
Obviously, such a hypothesis recalls the general phenomenological
notion of hyperreexivity (Sass, 1992)given the shared emphasis on
redirecting attentional resources to internal stimuli previously experienced only tacitly, and also on use of more conscious and deliberate
rather than spontaneous and automatic mental or action routines. But
whereas these authors describe hyperreexivity as entirely compensatory in nature (thus secondary in a pathogenetic sense: the topic of
article #2), we suggest that hyperreexivity, like disturbed selfpresence and disturbed grip, is something that can occur in both a
primary and a secondary fashion.
To conclude, the neurodevelopmental model views the advent of
psychosis in adolescence or early adulthood as a later stage of a disease
that typically evolves from risk to prodrome to psychosis to chronic disability. The neurologic and phenomenological abnormalities discussed
in this rst article seem present from early developmental stages, well
before development of frank psychotic symptoms. As we noted, evidence (regarding disrupted early intermodal integration in infants of
parents with schizophrenia) suggests that subjects prone to developing
schizophrenia might well have experiences of disturbed core-self from
early infancy.
It must be acknowledged, however, that disturbed perceptual or intermodal integrationat least as currently measured and conceivedis
not a sharply bounded, all-or-nothing phenomenon (Feigenson et al.,
2014). Also, not all persons showing such early disturbances do develop
a schizophrenia spectrum disorder (Srensen et al., 2010). We suggest
that the primary phenomenological abnormalities associated with
perceptual dys-integration are necessary but not sufcient to produce
the complete psychotic syndrome. It may be possible, in the future, to
identify a more specic, schizophrenia-related subset of these early
abnormalities. Another possibilityperhaps more likelyis that the secondary factors discussed in our followup article, along with associated
neural and psychological changes occurring during adolescence, might
constitute something like a second hit that is necessary to produce
the disease (Keshavan and Hogarty, 1999). It is possible, as well, that
persons who develop schizophrenia might differ in accord with the
relative importance that primary and secondary factors may have in
the pathogenesis of their difcultiesperhaps corresponding to what
have previously been considered the poor-vs-good-premorbid
or the negative-vs-positive-syndrome distinctions (depending on
whether a longitudinal or more cross-sectional perspective is
adopted; see article #2).
7. Discussion
Schizophrenia is a heterogeneous clinical syndrome that has not been
adequately captured by present categorical diagnostic classications or
the clinical practices derived from them. Stagnating psychiatric knowledge in this eld is now widely acknowledged (Insel, 2010; Carpenter
et al., 2013). Phenomenological assessment can complement current clinical and scientic approaches to schizophrenia by capturing more precisely the complex experiential phenomena of these patients. In this rst
article we have focused on the phenomenological changes postulated to
be primary or basic along with possible neurobiological correlates (perceptual dys-integration), with emphasis on clarifying complementary or
synchronic relations between different aspects of the self-disturbance.
These primary abnormalities generate in the subject a sense (often
novel) of change in the internal statechange that, at its most basic
level, is experienced in an automatic or largely passive form by patients
with schizophrenia.
We hypothesize that these abnormal experiences are closely related

to disrupted intermodal perceptual integration (perceptual dysintegration), already considered a core neurocognitive alteration in
schizophrenia, especially in patients with negative, disorganized, or
treatment-resistant types of schizophrenia. These difculties in intermodal perceptual integration, including integration of interoceptive processes,
can be understood as underlying disturbances in the three interconnected
or synchronic aspects of selfhood in schizophrenia, described in current
phenomenological psychopathology: disrupted grip or hold on the
world, operative hyperreexivity, and primary diminished selfpresence. They seem likely to disrupt the ability to apprehend the world
in holistic or vital fashion, or to fully identify with one's own body, thereby
generating an early and profound (albeit often subtle) disruption of basic
or core self in these patients. It is signicant that these perceptual and motoric abnormalities appear early in life, often in childhood, and long before
the appearance of psychotic symptomatology (Bilder et al., 2006;
Erlenmeyer-Kimling et al., 2000; Fis et al., 2008; Insel, 2010; Schenkel
and Silverstein, 2004).
Various publications have addressed the relationship between
phenomenology and neurobiology in schizophrenia; at least two have
considered the relationship between perceptual integration and selfdisturbance in schizophrenia (Parnas et al., 1996; Postmes et al.,
2014). What is novel in our account is the attempt to present a more detailed, theoretical formulation of the associations between each of three
aspects of core-self or ipseity disturbance and neurocognitive abnormalities. Progress in understanding the relation between the phenomenology and neurobiology of schizophrenia may require an integrated
consideration of several neurobiological alterations. This point will
emerge most clearly in a companion article that brings in phenomenological and neurobiological alterations arising secondarily, as consequential or compensatory responses to the more primary forms of
abnormal experience discussed herealso considered in light of the
neurodevelopmental model. Whereas this article focuses on synchronic
or complementary relationships, the subsequent article emphasizes
temporal or diachronic relationships between different aspects of the
self disturbance.
We acknowledge that association between neurological correlates
and the self-disturbance model of schizophrenia is somewhat speculative.
There is, however, growing evidence in recent years of the connection between prodromal neurologic alterations and early abnormal selfexperiences in these patients (Gamma et al., 2014; Raballo et al., 2011).
An integrated neurodevelopmental account of both neurocognitive and
phenomenological alterations in patients with schizophrenia may help
to advance diagnostic, preventive, and early therapeutic interventions
that could signicantly improve the course of illness in these patients.
Conict of interest
No conicts of interest.
Funding source
No nancial support for this project.
Acknowledgments
The authors are grateful to the anonymous reviewers for a number of useful criticisms
and suggestions.
References
Allen, P., Aleman, A., Mcguire, P.K., 2007. Inner speech models of auditory verbal hallucinations: evidence from behavioural and neuroimaging studies. Int. Rev. Psychiatry 19
(4), 407415.
Andreasen, N.C., 2007. DSM and the death of phenomenology in America: an example of
unintended consequences. Schizophr. Bull. 33 (1), 108112. http://dx.doi.org/10.
1093/schbul/sbl054.
Arzy, S., Mohr, C., Michel, C.M., Blanke, O., 2007. Duration and not strength of activation in
temporo-parietal cortex positively correlates with schizotypy. NeuroImage 35 (1),
326333. http://dx.doi.org/10.1016/j.neuroimage.2006.11.027.
Berlucchi, G., Aglioti, S., 1997. The body in the brain: neural bases of corporeal awareness.
Trends Neurosci. 20 (12), 560564.
Bhojraj, T.S., Francis, A.N., Rajarethinam, R., Eack, S., Kulkarni, S., Prasad, K.M., ... Keshavan,
M.S., 2009. Verbal uency decits and altered lateralization of language brain areas in
individuals genetically predisposed to schizophrenia. Schizophr. Res. 115 (23),
202208. http://dx.doi.org/10.1016/j.schres.2009.09.033.
Bhojraj, T.S., Sweeney, J.A., Prasad, K.M., Eack, S.M., Francis, A.N., Miewald, J.M., ...
Keshavan, M.S., 2011. Gray matter loss in young relatives at risk for schizophrenia:
relation with prodromal psychopathology. NeuroImage 54 (Suppl. 1), S272S279.
http://dx.doi.org/10.1016/j.neuroimage.2010.04.257.
Bilder, R.M., Reiter, G.L., Bates, J., Lencz, T., Szeszko, P., Goldman, R.S., et al., 2006. Cognitive
development in schizophrenia: follow-back from the rst episode. J. Clin. Exp.
Neuropsychol. 28 (2), 270282. http://dx.doi.org/10.1080/13803390500360554.
Blakemore, S.J., Wolpert, D.M., Frith, C.D., 1998. Central cancellation of self-produced
tickle sensation. Nat. Neurosci. 1 (7), 635640. http://dx.doi.org/10.1038/2870.
Brent, B.K., Seidman, L.J., Thermenos, H.W., Holt, D.J., Keshavan, M.S., 2014. Selfdisturbances as a possible premorbid indicator of schizophrenia risk: a
neurodevelopmental perspective. Schizophr. Res. 152 (1), 7380. http://dx.doi.org/10.
1016/j.schres.2013.07.038.
Brown, A.S., Derkits, E.J., 2010. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. Am. J. Psychiatry 167 (3), 261280. http://dx.doi.org/
10.1176/appi.ajp.2009.09030361.
Cannon, M., Jones, P.B., Murray, R.M., 2002. Obstetric complications and schizophrenia:
historical and meta-analytic review. Am. J. Psychiatry 159 (7), 10801092.
Carpenter Jr., W.T., Silverstein, S.M., Moghaddam, B., Wykes, T., 2013. How the diagnosis
of schizophrenia impeded the advance of knowledge (and what to do about it). In
Schizophrenia: Evolution and Synthesis: Strngmann Forum Reports. vol. 13.
Clair, S., Xu, D., Wang, M., Yu, P., Fang, Y., Zhang, Y., F., , He, L., 2005. Rates of adult
schizophrenia following prenatal exposure to the Chinese famine of 19591961.
JAMA 294 (5), 557562. http://dx.doi.org/10.1001/jama.294.5.557.
Cuesta, M.J., Peralta, V., Juan, J.A., 1996. Abnormal subjective experiences in schizophrenia: its relationships with neuropsychological disturbances and frontal signs. Eur.
Arch. Psychiatry Clin. Neurosci. 246 (2), 101105.
Damasio, A., 2010. Self Comes to Mind: Constructing the Conscious Brain. William
Heinemann, New York, NY.
Danckert, J., Saoud, M., Maruff, P., 2004. Attention, motor control and motor imagery in
schizophrenia: implications for the role of the parietal cortex. Schizophr. Res. 70
(23), 241261. http://dx.doi.org/10.1016/j.schres.2003.12.007.
De Leon, J., 2013. Is psychiatry scientic? A letter to a 21st century psychiatry resident. Psychiatry Investig. 10 (3), 205217. http://dx.doi.org/10.4306/pi.2013.
10.3.205.
de Vignemont, F., Zalla, T., Posada, A., Louvegnez, A., Koenig, O., Georgieff, N., Franck, N.,
2006. Mental rotation in schizophrenia. Conscious. Cogn. 15 (2), 295309. http://
dx.doi.org/10.1016/j.concog.2005.08.001.
Ehrsson, H.H., Holmes, N.P., Passingham, R.E., 2005. Touching a rubber hand: feeling of
body ownership is associated with activity in multisensory brain areas. J. Neurosci.
25 (45), 1056410573. http://dx.doi.org/10.1523/JNEUROSCI.0800-05.2005.
Ellison-Wright, I., Glahn, D.C., Laird, A.R., Thelen, S.M., Bullmore, E., 2008. The anatomy of
rst-episode and chronic schizophrenia: an anatomical likelihood estimation metaanalysis. Am. J. Psychiatry 165 (8), 10151023. http://dx.doi.org/10.1176/appi.ajp.
2008.07101562.
Emanuel, M., Jarus, T., Bart, O., 2008. Effect of focus of attention and age on motor acquisition, retention, and transfer: a randomized trial. Phys Ther 88 (2), 251260. http://
dx.doi.org/10.2522/ptj.20060174.
Erlenmeyer-Kimling, L., Rock, D., Roberts, S.A., Janal, M., Kestenbaum, C., Cornblatt, B.,
Adamo, U.H., Gottesman, I.I., 2000. Attention, memory, and motor skills as childhood
predictors of schizophrenia-related psychoses: the New York high-risk project. Am.
J. Psychiatry 157 (9), 14161422.
Feigenson, K.A., Gara, M.A., Roch, M.W., Silverstein, S.M., 2014. Is disorganization a
feature of schizophrenia or a modifying inuence: evidence of covariation of
perceptual and cognitive organization in a non-patient sample. Psychiatry Res.
217 (12), 18. http://dx.doi.org/10.1016/j.psychres.2014.03.005.
Ferri, F., Frassinetti, F., Mastrangelo, F., Salone, A., Ferro, F.M., Gallese, V., 2012. Bodily self
and schizophrenia: the loss of implicit self-body knowledge. Conscious. Cogn. 21 (3),
13651374. http://dx.doi.org/10.1016/j.concog.2012.05.001.
Fis, N.P., Cetin, F.C., Erturk, M., Erdogan, E., Dedeoglu, C., Yazgan, Y., 2008. Executive
dysfunction in Turkish children at high risk for schizophrenia. Eur. Child Adolesc.
Psychiatry 17 (7), 424431. http://dx.doi.org/10.1007/s00787-008-0684-x.
Fletcher, P.C., Frith, C.D., 2008. Perceiving is believing: a Bayesian approach to explaining
the positive symptoms of schizophrenia. Nat. Rev. Neurosci. 10 (1), 4858.
Frith, C.D., 1979. Consciousness, information processing, and schizophrenia. Br.
J. Psychiatry 134, 225235.
Frith, C.D., 2005. The neural basis of hallucinations and delusions. C. R. Biol. 328 (2),
169175.
Frith, C.D., Rees, G., Friston, K., 1998. Psychosis and the experience of self. Brain systems
underlying self-monitoring. Ann. N. Y. Acad. Sci. 843, 170178.
Frith, C.D., Blakemore, S., Wolpert, D.M., 2000. Explaining the symptoms of schizophrenia: abnormalities in the awareness of action. Brain Res. Brain Res. Rev. 31
(23), 357363.
Fuchs, T., 2010. Phenomenology and psychopathology. In: Gallagher, S., Schmicking, D. (Eds.),
Handbook of Phenomenology and Cognitive Science. Springer, New York, NY.
Gallagher, S., 2000. Phenomenological and experimental research on embodied experience. Atelier Phnomnologie Cogn Phenomenol Cogn Res Group CREA, Paris.
Gallagher, S., 2005. How the body shapes the mind. Cambridge Univ Press, Cambridge.
Gallese, V., Sinigaglia, C., 2010. The bodily self as power for action. Neuropsychologia 48
(3), 746755. http://dx.doi.org/10.1016/j.neuropsychologia.2009.09.038.
Gallese, V., Sinigaglia, C., 2011. How the body in action shapes the self. J. Conscious. Stud.
18 (78), 117143.
Gamma, F., Goldstein, J.M., Seidman, L.J., Fitzmaurice, G.M., Tsuang, M.T., Buka, S.L., 2014.
Early intermodal integration in offspring of parents with psychosis. Schizophr. Bull.
40 (5), 9921000.
Giummarra, M.J., Gibson, S.J., Georgiou-Karistianis, N., Bradshaw, J.L., 2008. Mechanisms underlying embodiment, disembodiment and loss of embodiment. Neurosci. Biobehav.
Rev. 32 (1), 143160. http://dx.doi.org/10.1016/j.neubiorev.2007.07.001.
Glahn, D.C., Laird, A.R., Ellison-Wright, I., Thelen, S.M., Robinson, J.L., Lancaster, J.L., ... Fox, P.T.,
2008. Meta-analysis of gray matter anomalies in schizophrenia: application of anatomic
likelihood estimation and network analysis. Biol. Psychiatry 64 (9), 774781. http://dx.
doi.org/10.1016/j.biopsych.2008.03.031.
Gogtay, N., Sporn, A., Clasen, L.S., Nugent, T.F., Greenstein, D., Nicolson, R., Giedd, J.N., et al.,
2004. Comparison of progressive cortical gray matter loss in childhood-onset schizophrenia with that in childhood-onset atypical psychoses. Arch. Gen. Psychiatry 61
(1), 1722. http://dx.doi.org/10.1001/archpsyc.61.1.17.
Gurwitsch, A., 1985. Marginal Consciousness vol. 7. Ohio University Press.
Haug, E., ie, M., Melle, I., Andreassen, O.A., Raballo, A., Bratlien, U., ... Mller, P., 2012. The
association between self-disorders and neurocognitive dysfunction in schizophrenia.
Schizophr. Res. 135 (13), 7983. http://dx.doi.org/10.1016/j.schres.2011.11.015.
Haug, E., ie, M., Andreassen, O.A., Bratlien, U., Raballo, A., Nelson, B., ... Melle, I., 2014.
Anomalous self-experiences contribute independently to social dysfunction in the
early phases of schizophrenia and psychotic bipolar disorder. Compr. Psychiatry 55
(3), 475482. http://dx.doi.org/10.1016/j.comppsych.2013.11.010.
Herrera, G., Jordan, R., Vera, L., 2006. Agency and presence: a common dependence on
subjectivity? Presence 15 (5), 539552.
Honea, R., Crow, T.J., Passingham, D., Mackay, C.E., 2005. Regional decits in brain volume in
schizophrenia: a meta-analysis of voxel-based morphometry studies. Am. J. Psychiatry
162 (12), 22332245. http://dx.doi.org/10.1176/appi.ajp.162.12.2233.
Hur, J.-W., Kwon, J.S., Lee, T.Y., Park, S., 2013. The crisis of minimal self-awareness in schizophrenia: A meta-analytic review. Schizophr. Res. http://dx.doi.org/10.1016/j.schres.
2013.08.042.
Husserl, E., 1977. Phenomenological Psychology. Springer Science & Business Media.
Insel, T.R., 2009. Translating scientic opportunity into public health impact: a strategic plan
for research on mental illness. Arch. Gen. Psychiatry 66 (2), 128133. http://dx.doi.org/
10.1001/archgenpsychiatry.2008.540.
Insel, T.R., 2010. Rethinking schizophrenia. Nature 468 (7321), 187193. http://dx.doi.
org/10.1038/nature09552.
James, W., 1950. The Principles of Psychology. Dover, New York.
Jeannerod, M., 2003. The mechanism of self-recognition in humans. Behav. Brain Res. 142
(12), 115.
Jones, P., 1994. Schizophrenia after prenatal exposure to the Dutch hunger winter of
19441945. Arch. Gen. Psychiatry 51 (4), 333334.
Kendall, T., 2011. The rise and fall of the atypical antipsychotics. J. Ment. Sci. 199 (4),
266268.
Kendler, K.S., 2009. An historical framework for psychiatric nosology. Psychol. Med. 39
(12), 19351941. http://dx.doi.org/10.1017/S0033291709005753.
Keshavan, M.S., Hogarty, G.E., 1999. Brain maturational processes and delayed onset in
schizophrenia. Dev. Psychopathol. 11 (3), 525543.
Kjaersdam Tellus, G., Jepsen, J.R., Bentz, M., Christiansen, E., Jensen, S.O.W., Fagerlund, B.,
Thomsen, P.H., 2015. Cognitive prole of children and adolescents with anorexia
nervosa. Eur. Eat. Disord. Rev. 23 (1), 3442. http://dx.doi.org/10.1002/erv.2337.
Knight, R.A., Silverstein, S.M., 1998. The role of cognitive psychology in guiding research
on cognitive decits in schizophrenia: a process oriented approach. In: Lenzenweger,
M., Dworkin, R. (Eds.), Origins and Development of Schizophrenia: Advances in Experimental Psychopathology. APA Press, Washington, DC, pp. 247295.
Lallart, E., Lallart, X., Jouvent, R., 2009. Agency, the sense of presence, and schizophrenia.
Cyberpsychol. Behav. 12 (2), 139145.
Li, X., Alapati, V., Jackson, C., Xia, S., Bertisch, H.C., Branch, C.A., Delisi, L.E., 2012.
Structural abnormalities in language circuits in genetic high-risk subjects and
schizophrenia patients. Psychiatry Res. 201 (3), 182189. http://dx.doi.org/10.
1016/j.pscychresns.2011.07.017.
Lutz, A., Thompson, E., 2003. Neurophenomenology integrating subjective experience
and brain dynamics in the neuroscience of consciousness. J. Conscious. Stud. 10
(910), 910.
Manoliu, A., Riedl, V., Doll, A., Buml, J.G., Mhlau, M., Schwerthffer, D., ... Sorg, C., 2013.
Insular dysfunction reects altered between-network connectivity and severity of
negative symptoms in schizophrenia during psychotic remission. Front. Hum.
Neurosci. 7, 216. http://dx.doi.org/10.3389/fnhum.2013.00216.
Manoliu, A., Riedl, V., Zherdin, A., Mhlau, M., Schwerthffer, D., Scherr, M., ... Sorg, C.,
2014. Aberrant dependence of default mode/central executive network interactions
on anterior insular salience network activity in schizophrenia. Schizophr. Bull. 40
(2), 428437. http://dx.doi.org/10.1093/schbul/sbt037.
Markov, I.S., Berrios, G.E., 2009. Epistemology of mental symptoms. Psychopathology 42
(6), 343349. http://dx.doi.org/10.1159/000236905.
Markov, I.S., Berrios, G.E., 2012. Epistemology of psychiatry. Psychopathology 45 (4),
220227. http://dx.doi.org/10.1159/000331599.
Martin, J.R., Pacherie, E., 2013. Out of nowhere: thought insertion, ownership and context-integration. Conscious. Cogn. 22 (1), 111122. http://dx.doi.org/10.1016/j.concog.2012.11.
012.
Merleau-Ponty, M., 2012. Phenomenology of perception. Trans: Donald Landes.
Routledge, London.
Miele, D.B., Wager, T.D., Mitchell, J.P., Metcalfe, J., 2011. Dissociating neural correlates of
action monitoring and metacognition of agency. J. Cogn. Neurosci. 23 (11),
36203636. http://dx.doi.org/10.1162/jocn_a_00052.
Mller, P., Haug, E., Raballo, A., Parnas, J., Melle, I., 2011. Examination of anomalous selfexperience in rst-episode psychosis: interrater reliability. Psychopathology 44 (6),
386390. http://dx.doi.org/10.1159/000325173.

Mulliken, G.H., Musallam, S., Andersen, R.A., 2008. Forward estimation of movement state
in posterior parietal cortex. Proc. Natl. Acad. Sci. U. S. A. 105 (24), 81708177. http://
dx.doi.org/10.1073/pnas.0802602105.
Naber, D., Lambert, M., 2009. The CATIE and CUtLASS studies in schizophrenia: results and
implications for clinicians. CNS Drugs 23 (8), 649659. http://dx.doi.org/10.2165/
00023210-200923080-00002.
Nelson, B., Whitford, T.J., Lavoie, S., Sass, L.A., 2014a. What are the neurocognitive correlates
of basic self-disturbance in schizophrenia?: integrating phenomenology and
neurocognition. Part 1 (source monitoring decits). Schizophr. Res. 152 (1), 1219.
http://dx.doi.org/10.1016/j.schres.2013.06.022.
Nelson, B., Whitford, T.J., Lavoie, S., Sass, L.A., 2014b. What Are the neurocognitive correlates
of basic self-disturbance in schizophrenia?: integrating phenomenology and
neurocognition: part 2 (aberrant salience). Schizophr. Res. 152 (1), 2027. http://dx.
doi.org/10.1016/j.schres.2013.06.033.
No, A., 2004. Action in perception. MIT press, Cambridge, MA.
Nordgaard, J., Parnas, J., 2014. Self-disorders and the schizophrenia spectrum: a study of 100
rst hospital admissions. Schizophr. Bull. 40 (6), 13001307. http://dx.doi.org/10.1093/
schbul/sbt239.
Nordgaard, J., Sass, L., Parnas, J., 2013. The psychiatric interview: validity, structure, and
subjectivity. Eur. Arch. Psychiatry Clin. Neurosci. 263 (4), 353364.
Nordgaard, J., Revsbech, R., Henriksen, M.G., 2015. Self-disorders, neurocognition and rationality in schizophrenia: a preliminary study. Psychopathology 48 (5), 310316.
http://dx.doi.org/10.1159/000435892.
O'Regan, J.K., No, A., 2001. A sensorimotor account of vision and visual consciousness.
Behav. Brain Sci. 24 (5), 939973 discussion 9731031.
Palmer, S.E., Nelson, R., 2000. Late inuences on perceptual grouping: illusory gures. Percept. Psychophys. 62 (7), 13211331.
Parnas, J., Henriksen, M.G., 2014. Disordered self in the schizophrenia spectrum: a clinical
and research perspective. Harv. Rev. Psychiatry 22 (5), 251265. http://dx.doi.org/10.
1097/HRP.0000000000000040.
Parnas, J., Bovet, P., Innocenti, G.M., 1996. Schizophrenic trait features, binding, and corticocortical connectivity: a neurodevelopmental pathogenetic hypothesis. Neurol. Psychiatry Brain Res. 4 (4), 185196.
Parnas, J., Mller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., Zahavi, D., 2005.
EASE: examination of anomalous self-experience. Psychopathology 38 (5),
236258. http://dx.doi.org/10.1159/000088441.
Parnas, J., Sass, L., Zahavi, D., 2013. Rediscovering psychopathology: the epistemology and
phenomenology of the psychiatric object. Schizophr. Bull. 39 (2), 270277. http://dx.
doi.org/10.1093/schbul/sbs153.
Parnas, J., Carter, J., Nordgaard, J., 2014. Premorbid self-disorders and lifetime diagnosis in
the schizophrenia spectrum: a prospective high-risk study. Early Interv. Psychiatry
http://dx.doi.org/10.1111/eip.12140.
Phillips, W.A., Silverstein, S.M., 2003. Convergence of biological and psychological
perspectives on cognitive coordination in schizophrenia. Behav. Brain Sci. 26 (1),
6582 (discussion 821370.
Piaget, J., Inhelder, B., 1969. The Psychology of the Child. Basic Books, New York.
Piper, M., Beneyto, M., Burne, T.H.J., Eyles, D.W., Lewis, D.A., McGrath, J.J., 2012. The
neurodevelopmental hypothesis of schizophrenia: convergent clues from epidemiology and neuropathology. Psychiatr. Clin. North Am. 35 (3), 571584. http://
dx.doi.org/10.1016/j.psc.2012.06.002.
Postmes, L., Sno, H.N., Goedhart, S., van der Stel, J., Heering, H.D., de Haan, L., 2014.
Schizophrenia as a self-disorder due to perceptual incoherence. Schizophr. Res.
152 (1), 4150. http://dx.doi.org/10.1016/j.schres.2013.07.027.
Raballo, A., Sbye, D., Parnas, J., 2011. Looking at the schizophrenia spectrum through the
prism of self-disorders: an empirical study. Schizophr. Bull. 37 (2), 344351. http://
dx.doi.org/10.1093/schbul/sbp056.
Rapoport, J.L., Giedd, J.N., Blumenthal, J., Hamburger, S., Jeffries, N., Fernandez, T., Nicolson, R.,
et al., 1999. Progressive cortical change during adolescence in childhood-onset schizophrenia. a longitudinal magnetic resonance imaging study. Arch. Gen. Psychiatry
56 (7), 649654.
Riva, G., Waterworth, J.A., Waterworth, E.L., 2004. The layers of presence: a bio-cultural approach to understanding presence in natural and mediated environments.
Cyberpsychol. Behav. 7 (4), 402416.
Rochat, P., 2009. The Infant's World. Harvard University Press, Cambridge, MA.
S Schwabe, L., Blanke, O., 2007. Cognitive Neuroscience of Ownership and Agency.
Conscious. Cogn. 16 (3), 661666. http://dx.doi.org/10.1016/j.concog.2007.07.
007.
Sass, L., 1992. Madness and modernism: insanity in the light of modern art, literature, and
thought. basic books, New York.
Sass, L., 2001. Self and world in schizophrenia: three classic approaches. Philos. Psychiatr
Psychol. 8 (4), 251270.
Sass, L., 2003. Negative symptoms, schizophrenia, and the self. Rev. Int Psicol Ter Psicol 3
(2), 153180.
Sass, L., 2004. schizophrenia: a disturbance of the thematic eld. Gurwitsch's Relevancy
for Cognitive Science. Springer, New York, NY, pp. 5978.
Sass, L., 2007. Contradictions of emotion in schizophrenia. Cogn. Emotion 21 (2),
351390.
Sass, L., 2010. In: Gallagher, S., Schmicking, D. (Eds.), Handbook of Phenomenology and
Cognitive Science. Springer, New York, NY.
Sass, L., 2014. Self-disturbance and schizophrenia: structure, specicity, pathogenesis (current issues, new directions). Schizophr. Res. 152 (1), 511. http://dx.doi.org/10.1016/j.
schres.2013.05.017.
Sass, L., 2016. Madness and modernism: insanity in the light of modern art, literature, and
thought. Revised Edition. Oxford University Press (in press).
Sass, L., Parnas, J., 2003. Schizophrenia, consciousness, and the self. Schizophr. Bull. 29 (3),
427444.
Sass, L., Parnas, J., Zahavi, D., 2011. Phenomenological psychopathology and schizophrenia:
contemporary approaches and misunderstandings. Philos. Psychiatry Psychol.
18 (1), 123.
Schenkel, L.S., Silverstein, S.M., 2004. Dimensions of premorbid functioning in
schizophrenia: a review of neuromotor, cognitive, social, and behavioral domains.
Genet. Soc. Gen. Psychol. Monogr. 130 (3), 241270. http://dx.doi.org/10.3200/
MONO.130.3.241272.
Schultze-Lutter, F., 2009. Subjective symptoms of schizophrenia in research and the clinic: the basic symptom concept. Schizophr. Bull. 35 (1), 58.
Schultze-Lutter, F., Ruhrmann, S., Picker, H., von Reventlow, H.G., Daumann, B.,
Brockhaus-Dumke, A., ... Pukrop, R., 2007. Relationship between subjective and objective cognitive function in the early and late prodrome. Br. J. Psychiatry Suppl. 51,
s43s51. http://dx.doi.org/10.1192/bjp.191.51.s43.
Shin, M.-S., Choi, H., Kim, H., Hwang, J.-W., Kim, B.-N., Cho, S.-C., 2008. A study of neuropsychological decit in children with obsessive-compulsive disorder. Eur. Psychiatry
23 (7), 512520. http://dx.doi.org/10.1016/j.eurpsy.2008.03.010.
Silveira, C., Marques-Teixeira, J., de Bastos-Leite, A.J., 2012. More than one century of
schizophrenia: an evolving perspective. J. Nerv. Ment. Dis. 200 (12), 10541057.
http://dx.doi.org/10.1097/NMD.0b013e318275d249.
Silverstein, S.M., Keane, B.P., 2011. Perceptual organization impairment in schizophrenia
and associated brain mechanisms: review of research from 2005 to 2010. Schizophr.
Bull. 37 (4), 690699. http://dx.doi.org/10.1093/schbul/sbr052.
Silverstein, S.M., Moghaddam, B., Wykes, T., 2014. Research strategies and priorities to improve the lives of people with schizophrenia: executive summary of the ernst
strungmann forum on schizophrenia. Schizophr. Bull. 40 (2), 259265.
Srensen, H.J., Mortensen, E.L., Schiffman, J., Reinisch, J.M., Maeda, J., Mednick, S.A., 2010.
Early developmental milestones and risk of schizophrenia: a 45-year follow-up of the
Copenhagen perinatal cohort. Schizophr. Res. 118 (1), 4147.
Stanghellini, G., 2009a. Embodiment and schizophrenia. World Psychiatry 8 (1), 5659.
Stanghellini, G., 2009b. The meanings of psychopathology. Curr. Opin. Psychiatry 22 (6),
559564. http://dx.doi.org/10.1097/YCO.0b013e3283318e36.
Stern, D.N., 2000. Interpersonal World of the Infant: A View from Psychoanalysis and
Development Psychology. Basic books, New York.
Synofzik, M., Vosgerau, G., Newen, A., 2008. I move, therefore I am: a new theoretical
framework to investigate agency and ownership. Conscious. Cogn. 17 (2), 411424.
http://dx.doi.org/10.1016/j.concog.2008.03.008.
Synofzik, M., Thier, P., Leube, D.T., Schlotterbeck, P., Lindner, A., 2010. Misattributions of
agency in schizophrenia are based on imprecise predictions about the sensory
consequences of one's actions. Brain 133 (Pt 1), 262271. http://dx.doi.org/10.
1093/brain/awp291.
Talamini, L.M., Meeter, M., 2009. Dominance of objects over context in a mediotemporal
lobe model of schizophrenia. PLoS One 4 (8), e6505. http://dx.doi.org/10.1371/
journal.pone.0006505.
Talamini, L.M., de Haan, L., Nieman, D.H., Linszen, D.H., Meeter, M., 2010. Reduced context
effects on retrieval in rst-episode schizophrenia. PLoS One 5 (4), e10356. http://dx.
doi.org/10.1371/journal.pone.0010356.
Tandon, R., 2012. The nosology of schizophrenia: toward DSM-5 and ICD-11. Psychiatr.
Clin. North Am. 35 (3), 557569. http://dx.doi.org/10.1016/j.psc.2012.06.001.
Tandon, R., 2014. Schizophrenia and other psychotic disorders in diagnostic and statistical
manual of mental disorders (DSM)-5: clinical implications of revisions from DSM-IV.
Indian J. Psychol. Med. 36 (3), 223225. http://dx.doi.org/10.4103/02537176.
135365.
Tandon, R., Nasrallah, H.A., Keshavan, M.S., 2009. Schizophrenia, Just the Facts 4. clinical
features and conceptualization. Schizophr. Res. 110 (13), 123. http://dx.doi.org/10.
1016/j.schres.2009.03.005.
Taylor, J.G., 2011. A neural model of the loss of self in schizophrenia. Schizophr. Bull. 37
(6), 12291247.
Thakkar, K.N., Nichols, H.S., McIntosh, L.G., Park, S., 2011. Disturbances in body ownership
in schizophrenia: evidence from the rubber hand illusion and case study of a spontaneous out-of-body experience. PLoS One 6 (10), e27089. http://dx.doi.org/10.1371/
journal.pone.0027089.
Thompson, B.L., Levitt, P., 2010. Now you see it, now you don'tclosing in on allostasis
and developmental basis of psychiatric disorders. Neuron 65 (4), 437439. http://
dx.doi.org/10.1016/j.neuron.2010.02.010.
Torrey, E.F., 2007. Schizophrenia and the inferior parietal lobule. Schizophr. Res. 97 (13),
215225. http://dx.doi.org/10.1016/j.schres.2007.08.023.
Tsakiris, M., 2010. my body in the brain: a neurocognitive model of body-ownership.
Neuropsychologia 48 (3), 703712. http://dx.doi.org/10.1016/j.neuropsychologia.
2009.09.034.
Tsakiris, M., Schtz-Bosbach, S., Gallagher, S., 2007. On agency and body-ownership: phenomenological and neurocognitive reections. Conscious. Cogn. 16 (3), 645660.
http://dx.doi.org/10.1016/j.concog.2007.05.012.
Tsakiris, M., Costantini, M., Haggard, P., 2008. The role of the right temporo-parietal junction in maintaining a coherent sense of one's body. Neuropsychologia 46 (12),
30143018. http://dx.doi.org/10.1016/j.neuropsychologia.2008.06.004.
Tyrer, P., Kendall, T., 2009. The spurious advance of antipsychotic drug therapy. Lancet
373 (9657), 45. http://dx.doi.org/10.1016/S0140-6736(08)61,7651.
Uhlhaas, P.J., Mishara, A.L., 2007. Perceptual anomalies in schizophrenia: integrating phenomenology and cognitive neuroscience. Schizophr. Bull. 33 (1), 142156.
Uhlhaas, P.J., Silverstein, S.M., 2005. Perceptual organization in schizophrenia spectrum
disorders: empirical research and theoretical implications. Psychol. Bull. 131 (4),
618632.
Uhlhaas, P.J., Phillips, W.A., Silverstein, S.M., 2005. The course and clinical correlates of
dysfunctions in visual perceptual organization in schizophrenia during the remission
of psychotic symptoms. Schizophr. Res. 75 (23), 183192. http://dx.doi.org/10.
1016/j.schres.2004.11.005.
10
Uhlhaas, P.J., Pantel, J., Lanfermann, H., Prvulovic, D., Haenschel, C., Maurer, K., Linden,
D.E.J., 2008. Visual perceptual organization decits in Alzheimer's dementia. Dement.
Geriatr. Cogn. Disord. 25 (5), 465475. http://dx.doi.org/10.1159/000125671.
Van den Bos, E., Jeannerod, M., 2002. Sense of body and sense of action both contribute to
self-recognition. Cognition 85 (2), 177187.
Varela, F.J., 1996. Neurophenomenology: A methodological remedy for the hard problem.
J. Conscious. Stud. 3 (4), 330349.
Voss, M., Moore, J., Hauser, M., Gallinat, J., Heinz, A., Haggard, P., 2010. Altered awareness
of action in schizophrenia: a specic decit in predicting action consequences. Brain
133 (10), 31043112. http://dx.doi.org/10.1093/brain/awq152.
Wylie, K.P., Tregellas, J.R., 2010. The role of the insula in schizophrenia. Schizophr. Res.
123 (2), 93104.
Zahorik, P., Jenison, R.L., 1998. Presence as being-in-the-world. Presence 7 (1), 7889.
Zanello, A., Huguelet, P., 2001. Relationship between subjective cognitive symptoms and
frontal executive abilities in chronic schizophrenic outpatients. Psychopathology 34
(3)), 153158. http://dx.doi.org/10.1159/000049299.

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Contents lists available at ScienceDirect

Phenomenology and neurobiology of self disorder in schizophrenia:

Dept of Mental Health, Ponticia Universidad Javeriana, Bogot, Colombia

categories, thereby producing validity difculties that undermine both

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

The model of an altered core or minimal self in schizophrenia has

Primary disturbed grip

Grounded in disturbed perceptual organization and integration, especially

Reective (or secondary) Hyperreexivity (a.k.a. hyper-reectivity)

Hypoactivity of Central Executive Network, and hyperactivity of

Ipseity = core, minimal, or basic self-experience.

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

Disturbances of both perceptual organization and integration have,

disturbed perceptual integration (perceptual dys-integration) is related

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

As we noted, the normal sense of agency inherent in performing an

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

We hypothesize that these abnormal experiences are closely related

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

J.P. Borda, L.A. Sass / Schizophrenia Research xxx (2015) xxxxxx

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