Experience of Self › Disturbance of the Boundaries of the Self

Passivity Phenomena

Passivity phenomena occur when a person experiences their own actions, movements, or feelings as being under the control of some outside power, rather than being genuinely their own. The person 'knows', with delusional conviction, that they are not the true author of what they are doing or feeling, and may attribute the controlling influence to something specific, such as hypnosis, radio waves, or the internet. This term specifically covers actions and feelings; the alienation of thought itself (thought insertion, withdrawal, and broadcasting) is closely related but documented separately.

This has traditionally been particularly associated with schizophrenia, once organic brain disorders have been excluded, and represents one of the clearest and most specific examples of a breakdown in the boundary between self and the external world.

Also known as

Made experience

A term for the specific quality of these experiences: the patient experiences their actions, feelings, or impulses as having been produced or fabricated by an outside influence.

Fabricated experience

Used interchangeably with 'made experience' to describe the same quality of an outside influence manufacturing the patient's actions or feelings.

Apophanous experience

Used specifically when the patient believes that events around them are being arranged or made to happen for their own benefit or significance.

Recognition features

• A conviction that one's own actions, movements, or feelings are being controlled or produced by an outside power, rather than being one's own
• Often attributed to a specific external mechanism, historically hypnosis or radio waves, and in contemporary accounts sometimes the internet or other technology
• Held with full delusional conviction, the patient 'knowing' rather than merely feeling that this is happening
• Distinct from, though closely related to, the alienation of thought itself, since passivity phenomena specifically concern actions and feelings rather than thoughts

Eliciting it at interview

• Ask directly: "Have you ever felt that your actions, movements, or feelings were not really your own, as though something or someone else was making you do or feel them?"
• If present, ask what the person believes is responsible for controlling them, and how they came to understand this
• Distinguish carefully from an obsessional urge to act, in which the impulse is experienced as belonging to the patient even though it occurs against their wishes, in contrast to passivity, where the action itself is not experienced as belonging to the patient at all
• Be alert to a milder, superficially similar presentation in severe anxiety, where difficulty thinking clearly and putting thoughts into words can lead a person to describe their thoughts or actions in terms that sound like passivity; careful questioning usually reveals these are offered with an 'as if' quality and without true delusional conviction, in contrast to the full, unqualified certainty of true passivity phenomena in schizophrenia, a distinction that matters a great deal for avoiding misdiagnosis

Distinguishing features

• Differs from an obsession or compulsion, in which the urge to act is recognised as the patient's own, however unwanted, whereas in a passivity phenomenon the action itself is experienced as belonging to someone or something else entirely
• Differs from thought insertion, thought withdrawal, and thought broadcasting, which concern the alienation of thought specifically, whereas passivity phenomena concern actions and feelings
• The apophanous quality, in which events are experienced as being arranged for the patient's benefit, extends the same 'made' quality outward to events in the world rather than only to the patient's own actions

Common misconceptions

• That passivity phenomena are the same as simply feeling coerced or pressured by another person; the experience here is of a specific, often bizarre external force literally producing the action or feeling itself
• That the person retains any doubt about the reality of the external control; passivity phenomena are held with full delusional conviction, not offered as a tentative impression
• That any 'as if' language about one's actions or thoughts being controlled from outside is automatically true passivity; severe anxiety can produce superficially similar 'as if' descriptions that lack the full, unqualified delusional conviction of genuine passivity phenomena, and telling the two apart is clinically important

Related phenomena

Disturbance of the Boundaries of the Self · Thought Alienation · Thought Broadcasting · Thought Insertion

Diagnostically relevant to

Schizophrenia (links open the DSM-5 Learning Lab)

Practice this

A man states, with complete conviction, that his own arm movements are not made by him but are directly controlled by a device implanted by a government agency, and that the fear he feels is likewise put into him by the same device rather than being his own feeling. What is this? · A woman says she sometimes feels a strong urge to check the front door repeatedly, which she recognises is excessive but cannot easily resist, and which she describes as 'like something is making me do it', though she agrees on further questioning that it is her own anxious urge and no outside force is actually controlling her body. Before revealing the answer: is this a passivity phenomenon? · A patient describes something unsettling about the sense that their actions belong to them. Before revealing the answer, decide what distinguishes disturbance of self-unity from a passivity phenomenon. · A patient describes a disturbing sense that something is being taken away or controlled by an outside force. Before revealing the answer, decide what distinguishes a passivity phenomenon from thought withdrawal. · You want to establish whether a patient is experiencing passivity phenomena. Before revealing the answer, decide what you would ask. · Explain why passivity phenomena are considered closely related to, but still distinct from, the alienation of thought seen in thought insertion, withdrawal, and broadcasting.

Illustration

A 29-year-old man tells his psychiatrist, with complete certainty, that his arm movements over the past week have not been his own, that a signal transmitted through his television has been directing them, and that he has simply been a passenger inside his own body while this has been happening, an account he gives calmly and without any doubt in its accuracy.

References

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