Experience of Self

Disturbance of Awareness of Self-Activity

This is a disturbance in the normal, background sense that one's own experiences, feelings, and actions belong to oneself. Ordinarily, everything a person thinks, feels, or does carries an automatic, unremarked sense of personal ownership; this is disturbed when that ownership either weakens, so the person feels detached from their own existence and doings, or is lost from awareness of emotional response, so the person feels unable to feel.

This has traditionally been framed, following Jaspers, as one of four fundamental aspects of self-experience, alongside the awareness of being a unity, of continuity of identity, and of being separate from the environment; this particular aspect concerns the sense of one's own existence and the ownership of one's own actions.

Recognition features

• A weakened or lost sense that one's own thoughts, feelings, and actions genuinely belong to and are performed by oneself
• May be experienced as feeling detached from one's own existence, or from the normal ability to feel emotionally
• The person retains awareness that this is a change in how things feel to them, rather than holding a fixed false belief about it
• Its two principal recognised manifestations are depersonalisation (and its environmental counterpart, derealisation) and loss of emotional resonance

Eliciting it at interview

• Ask in plain language whether the person has ever felt detached from themselves, as though they are not their normal self, or unable to feel the way they usually would
• Explore whether this sense of detachment applies mainly to the person's own self and actions, or to how the surrounding world feels, since this distinguishes depersonalisation from derealisation
• Check specifically whether emotional responsiveness itself feels blunted or absent from the inside, even where an observer would see no obvious change, which points toward loss of emotional resonance

Distinguishing features

• Differs from a nihilistic delusion, in which the person holds a fixed false belief that they do not exist or are dead, rather than describing a distressing but recognised change in how existence feels
• Differs from a disturbance of self-unity, which concerns feeling like more than one person rather than a diminished sense of one's own activity and existence
• Differs from affect blunting (a morbid expression of emotion), which is an outward reduction in emotional display observable to others, whereas loss of emotional resonance here is a subjectively felt inability to feel, often without any visible change

Common misconceptions

• That any disturbance here implies psychosis; depersonalisation and related experiences are common in the general population, particularly under severe tiredness or acute stress, and do not by themselves indicate a psychotic illness
• That the person's account of feeling unreal or unable to feel reflects a delusional belief; insight into the change being subjective and abnormal is a defining and reassuring feature

Related phenomena

Depersonalisation · Derealisation · Loss of Emotional Resonance · Disturbance of the Immediate Awareness of Self-Unity

Practice this

A patient describes a persistent, distressing feeling that her own thoughts and actions no longer feel like they belong to her, though she recognises this as a strange change in how things feel rather than believing she has ceased to exist. What is this? · A severely depressed elderly patient states with complete conviction that she has already died and that her body is now empty inside, and cannot be persuaded otherwise despite clear evidence to the contrary. Before revealing the answer: is this a disturbance of awareness of self-activity? · A patient describes a profound, distressing change in how their own existence feels. Before revealing the answer, decide what distinguishes disturbance of awareness of self-activity from a nihilistic delusion. · A patient describes a disturbed relationship between themselves and their thoughts or actions. Before revealing the answer, decide what distinguishes disturbance of the boundaries of the self from disturbance of awareness of self-activity. · You suspect a patient has a disturbance of awareness of self-activity. Before revealing the answer, decide how you would assess for this. · Explain why retained insight is described as the key feature separating a disturbance of awareness of self-activity from a nihilistic delusion.

Illustration

A 26-year-old man describes, during a period of severe work-related stress, feeling as though he is watching himself go through his daily routine from a slight distance, and separately mentions that he no longer feels the warmth he expects to feel when greeting his young daughter after work, both changes he finds distressing precisely because he recognises how different they are from how things normally feel.

References

• Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 7, 'Disorders of the Experience of Self'.