Abstract
Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.
Highlights
What Is Self-Other Distinction and Why Is It Important?Humans are innately wired to respond to others’ emotional states
Many neuropsychiatric disorders feature emotional, cognitive and/or motor features that are likely to indicate problems with self-other distinction. Within each of these domains, we may identify both signs of low self-other distinction, and characteristics or behaviors that could constitute secondary effects or coping strategies which serve to increase self-other distinction
Cognitive features associated with poor self-other distinction may manifest as paranoia or projection, and potential coping strategies include avoidance of perspective taking or buffering sense of self through grandiosity or impulsive non-conformity
Summary
Humans are innately wired to respond to others’ emotional states. Most of us understand what it is to vicariously feel other’s pain, and if we are lucky, their happiness. High vs low sense of agency and self-esteem associated with grandiose traits vs vulnerable traits respectively, in non-clinical sample [149] Lower self-reported perspective taking vs HCs [36] Lower self-reported perspective taking vs HCs [37] Lower self-reported perspective taking vs HCs [40] Problem with explicit perspective taking but not necessarily empathy [150] Cognitive perspective taking can be reduced [151] Most likely to be reduced when affect is involved and may depend on subtype [152–154] Coprophenomena and non-obscene socially inappropriate urges that tend to be ego-dystonic [155–157] Impulsive non-conformity is associated with atypical emotional prosody processing [158]; high in schizotypy in association with reasoning about actions based on emotions [159]; negatively correlated with anhedonia [160] Ego-dystonic intrusive thoughts about harming others [161] associated with proposed ‘self-defeating’ personality disorder [162, 163] Acute agitation and aggression [164] and problem behaviors which may be related to coping skills [165] Emotional dysregulation linked to splitting, projection and acting out [166]. Few studies have attempted to explore specific associations
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