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?
No, this is more consistent with a nihilistic delusion than a disturbance of awareness of self-activity. Here the patient holds a fixed false belief that she does not exist or is dead, held with full conviction and unmoved by clear counter-evidence, rather than describing a distressing but recognised change in how things feel with insight retained, which is the defining pattern of disturbance of self-activity.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 7, 'Disorders of the Experience of Self'.