Degree

Doctor of Philosophy (PhD)

Department

Psychology

Document Type

Dissertation

Abstract

Schizophrenia is associated with significant decreases in functioning and costly psychiatric hospitalization. However, it is frequently misdiagnosed due to phenotypic overlap with other disorders, and misdiagnosis can contribute to its functional and economic cost. Schizotypy and psychosis risk syndrome frameworks have been used to predict who will eventually develop schizophrenic psychosis, but accurate prediction caps at about 30% for individuals who are identified as “at risk” by these frameworks. Anomalous Self Experience (ASE), an alternative framework for understanding psychosis risk developed by phenomenological psychiatry, proposes that identifying fundamental alterations to sense of self are specific to schizophrenia and distinguish those who will eventually develop schizophrenia. Theorists have proposed that “Primary” ASE, reflecting genuine schizophrenia risk, is a trait-like construct that is stable over time, while “Secondary” ASE may emerge as a compensatory reaction to symptoms of non-schizophrenia disorders and may be more responsive to environmental context. This study assessed non-clinical participants’ (n=218; mean age = 19.69 years; 81.65% female; 70.64% white) schizophrenia risk via schizotypy, as well as trait-like ASE, and momentary ASE using ecological momentary assessment to obtain an ecologically-valid pictures of participants’ self-experience. Cluster analyses including trait ASE, schizotypy and intraindividual variability of momentary ASE were performed to determine if ASE variability distinguished participants without schizophrenia risk. Hierarchical multilevel modeling was performed to determine whether momentary ASE was dependent on social and emotional context for individuals with Secondary ASE over others. Exploratory analyses investigated the relationships between comorbid psychopathology and Primary vs. Secondary ASE. Results indicated that individuals with Secondary ASE demonstrated high momentary ASE which was independent of schizotypy, strongly related to context over the Primary ASE group, and likely related to dissociative-like factors. Against expectations, a High Profile group demonstrated highly variable momentary ASE which correlated with schizotypy and negative emotional context. The results of this study demonstrate the feasibility of using ecological momentary assessment to assess momentary ASE as a separate construct from trait ASE, and lend preliminary support for a distinction between Primary and Secondary ASE. Implications for the use of ASE in the evaluation of psychosis risk are discussed.

Date

7-14-2025

Committee Chair

Cohen, Alex S.

DOI

10.31390/gradschool_dissertations.6862

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