First-Rank Symptoms of Schizophrenia

Abstract

Coined in 1939 by K. Schneider (KS), the concept of the first-rank symptoms (FRS) of schizophrenia covers a selection of symptoms allegedly of first-rank importance for the differential diagnosis between schizophrenia and cyclothymia (bipolar disorder). Following a tortuous path, the FRS were eventually adopted as diagnostic criteria in the operational definitions of DSM-III and ICD-10 schizophrenia. FRS consist of three areas of psychopathology: delusional perception, phenomena of passivity or influence, and certain verbal-acoustic hallucinations. The basic psychopathology governing these phenomena are self-disorders like self-alienation, transitivism, and solipsism, well-known for clinicians of that time. The question of the diagnostic significance of FRS hangs on their definition. Deprived of their basic psychopathological structure and hence their specific quality through “operationalization,” the FRS no longer appear specific for schizophrenia. The proposed inclusion of self-disorders in the diagnostic criteria for ICD-11 schizophrenia exemplified by passivity phenomena may, however, serve to counteract this trend.