Associations between Self-Disorders and First-Rank Symptoms: An Empirical Study.
BACKGROUND
The diagnostic weight of the first-rank symptoms was deemphasized in DSM-5 and a similar change is expected in ICD-11. This change was motivated by a lack of solid, empirical evidence of the diagnostic significance of first-rank symptoms for schizophrenia. Yet, it seems that Schneider's original concept of first-rank symptoms was overly simplified when it was introduced in DSM-III. Specifically, it was overlooked that first-rank symptoms, in Schneider's understanding, fundamentally involve a disorder of the self. The aim here is to empirically test Schneider's claim that first-rank symptoms involve self-disorders.


METHODS
In a modified, cross-sectional study of 98 first-admission patients, the relation between lifetime presence of first-rank symptoms and self-disorders was examined. Self-disorders were examined with the EASE (Examination of Anomalous Self-Experiences).


RESULTS
We found an odds ratio of 1.56 (95% CI 1.10-2.21) for having first-rank symptoms for each 5-point increase in the EASE (measuring self-disorder) using a generalized linear mixed model regression. We did not find first-rank symptoms in the absence of self-disorders.


CONCLUSION
The close relation between first-rank symptoms and self-disorders seems to support Schneider's original concept of first-rank symptoms. We suggest that first-rank symptoms occurring without the pervasively altered self-experiences might not be different from other psychotic phenomena in terms of their diagnostic significance. Awareness of self-disorders can help clinicians in assessing and detecting first-rank symptoms.
['Nordgaard|Julie|J|', 'Henriksen|Mads Gram|MG|', 'Berge|Jonas|J|', 'Siersbæk Nilsson|Lars|L|']
D000328:Adult D003430:Cross-Sectional Studies D039721:Diagnostic and Statistical Manual of Mental Disorders D005260:Female D006801:Humans D008297:Male D011618:Psychotic Disorders
EASE Anomalous self-experience Diagnoses Psychosis Schizotypal disorder Schneiderian