Abstract
Background: Major depressive disorder (MDD) is an affective disorder that is harmful to both physical and mental health. Abnormal self-knowledge, which refers to abnormal judgments about oneself, is a core symptom of depression. However, little research has summarized how and why patients with MDD differ from healthy individuals in terms of self-knowledge.Objective: To gain a better understanding of MDD, we reviewed previous studies that focused on the behavioral and neurological changes of self-knowledge in this illness.Main Findings: On the behavioral level, depressed individuals exhibited negative self-knowledge in an explicit way, while more heterogeneous patterns were reported in implicit results. On the neurological level, depressed individuals, as compared with non-depressed controls, showed abnormal self-referential processing in both early perception and higher cognitive processing phases during the Self-Referential Encoding Task. Furthermore, fMRI studies have reported aberrant activity in the medial prefrontal cortex area for negative self-related items in depression. These results revealed several behavioral features and brain mechanisms underlying abnormal self-knowledge in depression.Future Studies: The neural mechanism of implicit self-knowledge in MDD remains unclear. Future research should examine the importance of others' attitudes on the self-concept of individuals with MDD, and whether abnormal self-views may be modified through cognitive or pharmacological approaches. In addition, differences in abnormal self-knowledge due to genetic variation between depressed and non-depressed populations remain unconfirmed. Importantly, it remains unknown whether abnormal self-knowledge could be used as a specific marker to distinguish healthy individuals from those with MDD.Conclusion: This review extends our understanding of the relationship between self-knowledge and depression by indicating several abnormalities among individuals with MDD and those who are at risk for this illness.
Highlights
IntroductionMajor depressive disorder (MDD) is a complicated affective disease characterized by abnormal clinical symptoms, including neurovegetative dysfunction (appetite or sleep disturbances), cognitive dissonance (inappropriate guilt, feelings of worthlessness), aberrant psychomotor activities (agitation or retardation) [1], and elevated suicide risk [2, 3]
Major depressive disorder (MDD) is a complicated affective disease characterized by abnormal clinical symptoms, including neurovegetative dysfunction, cognitive dissonance, aberrant psychomotor activities [1], and elevated suicide risk [2, 3]
MDD is a main cause of disease burden worldwide [6, 7], and abnormal self-knowledge is one of the cardinal symptoms of this disorder
Summary
Major depressive disorder (MDD) is a complicated affective disease characterized by abnormal clinical symptoms, including neurovegetative dysfunction (appetite or sleep disturbances), cognitive dissonance (inappropriate guilt, feelings of worthlessness), aberrant psychomotor activities (agitation or retardation) [1], and elevated suicide risk [2, 3]. Abnormal perception and understanding of the self is a core symptom of MDD [1]. This includes abnormal processes and/or representations involved in being aware of the self, abnormal knowledge about the self, and/or abnormal judgments about the self (National Institute of Mental Health; NIMH). As a sub-construct of perception and understanding of the self, self-knowledge, which refers to the ability to make judgments about one’s current cognitive or emotional internal states, traits, and/or abilities (NIMH), is impaired in individuals with MDD [8,9,10,11]. Little research has summarized how and why patients with MDD differ from healthy individuals in terms of self-knowledge
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