Distinguishing Oneself From Others: Spontaneous Perspective-Taking in First-Episode Schizophrenia and its relation to Mentalizing and Psychotic Symptoms

Abstract

Abstract Characteristic symptoms of schizophrenia, such as thought broadcasting, verbal hallucinations, and delusions of being controlled, suggest a failure in distinguishing between oneself and others. In addition, patients frequently experience mentalizing deficits, which could be related to such a failure. Here we investigated the tendency to distinguish self and other with a visual perspective-taking task that measures to what extent individuals spontaneously take another’s perspective when having to process their own (altercentric intrusion) or vice versa (egocentric intrusion). This was done in 22 patients with first-episode schizophrenia and 23 matched healthy controls. We assessed whether patients displayed altered altercentric or egocentric intrusion and whether such alterations are related to mentalizing deficits—as measured with the Animated Triangles Task (ATT) and The Awareness of Social Inference Task (TASIT) —and/or specific psychotic symptoms, suggestive of problems with self-other distinction. The results showed that patients display similar egocentric intrusion and increased altercentric intrusion compared to controls. Degree of altercentric intrusion was associated with severity of delusions and hallucinations that have been tied to problems with self-other distinction but not with unrelated delusions and hallucinations or negative symptom severity. Higher altercentric intrusion was also associated with better TASIT performance in both patients and controls; suggesting that it may also be beneficial. In conclusion, patients display difficulties inhibiting representations of the other when having to process self-relevant information. A failure to control or distinguish the 2 representations could give rise to the experience that others have access to and control of your thoughts and actions.