Ego Pathology Research Articles

Evaluation of trait adjectives and ego pathology in schizophrenia: An N400 study

The N400, an event-related brain potential (ERP), can be triggered by semantic or arithmetic violations in visual or auditory stimulus material. Schizophrenia patients exhibit an altered N400 presumably resulting from impaired semantic memory associative networks. The present study investigates, whether an altered N400 can also be found in semantic violations of the own self-concept. We use simple descriptive sentences to combine semantics with the self-concept in order to explore differences and possible deficits in schizophrenia patients.Schizophrenia patients and controls were shown trait adjectives in reference to themselves. Participants had to decide if the presented trait adjective was congruent or incongruent with their own self-concept. Only in controls, the N400 was significantly more negative in the incongruent compared to the congruent condition. Controls seemed to profit from a stable self-concept as they were faster in judging if a given trait was descriptive for the self than for someone else, which might result from processes related to the self-reference effect. Interestingly, in schizophrenia patients, the higher the scores for ego pathology were, the smaller the N400 effect turned out to be. The diminished N400 effect is probably associated with a disturbed self-concept in schizophrenia.

Entwicklung und Validierung eines Fragebogens zu Ich-Funktionen und zur Selbstregulationsfähigkeit (Hannover-Selbstregulations-Inventar, HSRI)

The aim of this study was to construct and validate a short self-rating questionnaire for the assessment of ego functions and ability of self regulation. An item pool of 120 items covering 6 postulated dimensions was reduced by two steps in independent samples (n = 136 + 470) via factor and item analyses to the final version consisting of 35 items. The 5 resulting questionnaire scales "interpersonal disturbances", "frustration tolerance and impulse control", "identity disturbances", "affect differentiation and affect tolerance" and "self-esteem" were well interpretable and showed in confirmatory factor analysis the best fit to the data (CHI²/df = 3.48; RMSEA = 0.73). Total scores were found to differentiate well between diagnostic groups of patients with more or less ego pathology (FANOVA = 9.8; df = 11; p < 0.001), thus proving good concurrent validity. Reliability was shown by testing internal consistency and test-retest correlations. The "Hannover self-regulation questionnaire" (HSRQ) evidently is an appropriate and reliable screening instrument in order to assess ego functions and capacities of self regulation in an economic and user-friendly means. The scale structure allows differentiated diagnostics of weak vs. stable ego functions and may be used for detailed therapy planning.

P01-397 - Clinical relevance of self-disorders (Ich-Störungen) in schizophrenia: a review of studies on diagnosis, factor structure and outcome

ObjectiveThe notion of “Ich-Störungen” (self-disorders) depicts a major aspect of Kurt Schneider's concept of first rank symptoms of schizophrenia. Terms such as “passivity phenomena”, “delusions of alien control” and “ego pathology” have been used to characterise these phenomena once postulated to be pathognomonic for schizophrenia. The present review focuses on clinical studies examining the symptoms’ diagnostic and nosological implications.MethodsWe conducted a semi-structured literature review. 374 references were obtained using the key words “ego disorder/(psycho)pathology”, “thought insertion”, “alien control”, “passivity symptoms/phenomena/experiences”, “first rank symptoms”, “schneiderian” and “self disorders”. We distinguished two major fields of research:(1)neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms;(2)studies on diagnosis and nosology (including assessment instruments and factor analyses), outcome and prognostic value.Of the studies on the second field, 83 have clinical relevance and are reviewed here.ResultsSeveral specific instruments with sound foundations in psychopathology have been developed for the assessment of self-disorders; however, they have rarely been included in research. Factor analyses have consistently shown a highly loaded factor consisting of self-disorders, in some studies distinct from other first-rank symptoms. There is contradictory data on outcome and prognosis.ConclusionsSelf-disorders remain ill-defined and inconsistently included into diagnostic criteria, and therefore lack nosological significance. Their clinical relevance has been insufficiently studied, although they have been consistently shown to form a highly specific factor within the schizophrenia symptom spectrum. The present review stresses the need for a global definition of self-disorders on the basis of phenomenology.

The association of religiosity, spirituality, and ethnic background with ego-pathology in acute schizophrenia

Studies have highlighted the impact of ego-consciousness, religiosity and spirituality on psychotic symptoms, although so far no study has investigated if and how these factors may be interrelated. In this exploratory cross-sectional study, involving 42 patients with a diagnosis of acute paranoid schizophrenia (DSM-IV), we assessed religiosity (Religious Orientation Test) spirituality (Spiritual Transcendence Scale) and ego-pathology (Ego Pathology Inventory) and analysed any relationship with these and psychopathological symptoms (Positive and Negative Symptom Scale). The subjects were divided into four ethnic groups (Caucasian, Afro-Caribbean, African, and Asian) and a structured, qualitative interview on religious needs and self-concepts was also conducted. Using a multivariate analysis, we found statistically significant negative associations between the scores on ego and common pathology and religiosity and spirituality as covariates. This was seen across all ethnic groups. The findings are discussed in respect of the potential clinical importance of ethnic, religious and spiritual factors for assessment and management of patients with schizophrenia.

Executive dysfunction, self, and ego pathology in schizophrenia: an exploratory study of neuropsychology and personality

Schizophrenic patients show a variety of symptoms, including positive and negative symptoms and ego pathology. Their exact underlying neuropsychological mechanisms as well as related changes in personality, however, remain unclear. We therefore conducted an exploratory study to investigate the relationship among neuropsychological functions, various dimensions in personality, and the different kinds of psychopathological symptoms. We investigated 22 paranoid schizophrenic patients and 22 age- and sex-matched healthy controls using a battery of neuropsychological, personality, and psychopathological tests and scales. Neuropsychological tests included executive function, working memory, and episodic memory, whereas personality assessment relied on the Temperament and Character Inventory by Cloninger ( Arch Gen Psychiatry. 1987;44:573-88). Psychopathological rating included the scales for the assessment of positive and negative symptoms and the Ego Pathology Inventory by Scharfetter ( Psychol Med. 1981;11(2):273-80). Schizophrenic patients showed significant deficits in executive function, working memory, and episodic memory. In contrast to healthy subjects, no significant correlation between working memory and executive function was observed in schizophrenic patients. Instead, both working memory and executive dysfunction were rather related to deficits in retrieval of episodic memory. Positive and negative symptoms correlated with episodic memory deficits but not with any dimension of the personality, whereas ego pathology, in contrast, correlated with executive dysfunction and working memory deficits. Moreover, schizophrenic patients showed specific changes in the self-dimensions of their personality, which correlated significantly with both executive dysfunction and ego pathology. Schizophrenic patients show deficits in working memory and executive function as well as functional dissociation between both. In contrast to positive and negative symptoms, ego pathology in these patients is specifically related to executive dysfunction and alterations in the self-dimension of their personality. It can therefore be concluded that ego pathology must be distinguished from positive and negative symptoms in both underlying neuropsychological dysfunction and predisposing changes in personality.

Metabolic hyperfrontality and psychopathology in the ketamine model of psychosis using positron emission tomography (PET) and [ 18F]fluorodeoxyglucose (FDG)

To date, the ketamine/PCP model of psychosis has been proposed to be one of the best pharmacological models to mimic schizophrenic psychosis in healthy volunteers, since ketamine can induce both positive and negative symptoms of schizophrenia. At subanesthetic doses, ketamine has been reported to primarily block N-methyl- d-aspartate (NMDA) receptor complex giving support to a glutamate deficiency hypothesis in schizophrenia. Positron emission tomography was used to study ketamine-induced psychotic symptom formation in relation to cerebral metabolic alterations in healthy volunteers. Our study shows that NMDA receptor blockade results in a hyperfrontal metabolic pattern. Increased metabolic activity in the frontomedial and anterior cingulate cortex correlated positively with psychotic symptom formation, in particular with ego pathology. Analysis of correlations between syndrome scores and metabolic rate of glucose (CMRglu) or metabolic gradients (ratios) revealed that each psychopathological syndrome was associated with a number of metabolic alterations in cortical and subcortical brain regions, suggesting that not a single brain region, but distributed neuronal networks are involved in acute psychotic symptom formation.

Ego functioning in eating disorders: Prediction of outcome after one and two years

This study prospectively investigated the prognostic significance over 1 and 2 years of objectively assessed ego functioning in a group of 37 eating disordered patients. Previously, ego functioning was found to vary substantially within the group, and to be unrelated to symptomatic aspects (Norring et al., 1989). Differences in ego pathology proved to be a strong predictor of status in terms of overall mental health, work adjustment, and self-rated emotional problems, and was superior to other variables (e.g., binge eating, duration) in this respect. More specifically, deficits in the regulation of self-esteem were suggested to be particularly important for prognosis. Status in terms of eating disorder symptomatology was predicted strongly the first year, but not the second. Post hoc analyses suggested that during the second year those with more severe ego disturbances caught up on the advantage held by the others. It is concluded that differences in ego pathology are of importance for prognosis with respect to overall psychological and social functioning in eating disorders, and may be so for the eating disturbance itself.

Identity integration and ego pathology in disturbed adolescents.

Utilizing the Rorschach and the Wechsler, groups of borderline adolescents (n = 26) and adolescents with other personality disorders (n = 26) were compared to determine whether there were differences in magnitude and type of disturbances in ego functioning. The specific aspects of ego functioning that were studied included disturbances in identity integration, reliance on primitive defensive operations, vulnerability to regressive thinking, and lapses in reality appreciation. Results indicated that during adolescence the borderline personality represents a more severe form of character pathology than other personality disorders, as revealed by more disturbances in identity integration, a greater regression to primary-process thinking in unstructured settings, and more frequent lapses in reality testing. This contrast was most striking in the area of identity integration, where identity disturbances tended to be associated with lapses in reality testing in borderline adolescents, while there was essentially no relationship between these two indicators of ego pathology in non-borderline adolescents. This supports the notion that disturbances in identity integration, or the sense of self, form an important part of the borderline diagnosis, even during adolescence.

The different narcissistic disturbances of personality and their psychotherapeutic approach.

Narcissism is defined as the self-representation which gives to the instances ego, id and superego as well as to the body the narcissistic cathexis which makes the individual feel an entity and continuity. Three kinds of narcissistic disorders are differentiated concerning their psychodynamics: Narcissistic personality disorders (narcissistic neuroses) with an ego basically able to function well, but a lack in the self; borderline conditions with a more or less severe ego pathology and the consecutive difficulty of the concerned individual to build up a consistent self; major depressions with a more or less pronounced emptiness or evacuation in the realm of narcissism. The psychotherapy of these three disorders is explained. The psychotherapy of narcissistic personality disorders (narcissistic neuroses) consists in a slightly modified psychoanalytic approach. The psychotherapy of borderline patients is described as an analytically oriented expressive one. The psychotherapy of major depressions consists in the depressive phases mainly of an empathic approach. In the intervals not only the almighty superego, but also the huge oral and narcissistic expectations as well as the defense mechanisms of the patients against them, as e.g. the lifelong pattern of law and order, should be worked through.

Ego boundary disturbance in juvenile anorexia nervosa.

Tested the hypothesis that ego boundary disturbance is present in adolescent females with anorexia nervosa. Twenty anorexics were compared to 20 female depressed controls on Rorschach scales designed to measure theoretically relevant aspects of boundary impairment. Results showed that anorexics scored higher on scales that measure inner-outer and conceptual boundary disturbance and produced significantly more responses that emphasized the solidity of object boundaries. Boundary scores were unrelated to degree of weight loss and global symptom severity, and follow-up testing after normal weight was restored revealed little change from initial levels. These findings are discussed in relation to current theory on the role of developmental ego pathology in the origins and phenomenology of anorexia nervosa.

Diagnosis and treatment of borderline personality organization

This paper describes the diagnostic and therapeutic approach to borderline personality organization proposed by Otto Kernberg. Diagnosis is based primarily on the characteristic ego pathology which includes the mechanism of splitting, defined as the defensive separation of “good” and “bad” self and object representations. The therapeutic strategy emphasizes systematic exploration of the negative transference and the pathological defenses. A case is presented to illustrate the applicability of Kernberg's concepts to the therapy of a borderline client treated by a clinical social worker on a once-a-week outpatient basis.

Ego Pathology: Diagnostic and Treatment Implications

Ego Pathology: Diagnostic and Treatment Implications

Recidivism, Crime, and Delinquency: A Psychoanalyst's Perspective

A comprehensive review of the subject of recidivism is presented. It is found that sociological and simplistic psychological theories of crime and delinquency fail to explain variation in individual outcome under similar social conditions. It seems that severely deprived and traumatized children from disorganized multiproblem families commonly develop ego pathology typical of the borderline disorders, and contribute disproportionately to the numbers of recidivist delinquents. In a classification of adult criminal behavior based on the nature and severity of disturbances in the three mental agencies, it is found that the less the ego pathology, the more is criminal behavior attributable to disturbances of superego development.

Ego autonomy and ego pathology.

Ego autonomy and ego pathology.

Increased blood serotonin and platelets in early infantile autism.

BASED on extensive clinical observations, we have suggested that children whose conditions are variously diagnosed as early infantile autism, atypical ego development, symbiotic psychosis, and certain cases of childhood schizophrenia suffer from a unitary disease. 1 Their symptoms can be grouped in five subclusters involving disturbances of (1) perception, (2) motility, (3) developmental rate, (4) relationships to people and objects, and (5) language. It appears that the disturbances of perception, motility, and developmental rate are expressive of a primary neuropathophysiologic dysfunction 2,3 which leads to disturbances of relating and language. The more severe and prolonged the neuropathophysiologic process, the more pervasive is the resultant ego pathology. In seeking evidence to support these hypotheses, we have compared autistic children and age-matched controls on certain measures of neurophysiologic function and integration. The results of these studies have been reported in detail elsewhere. 4-7 They indicate that normals and autistics differ in

The effects of subliminally presented drive stimuli on the cognitive functioning of schizophrenics.

Abstract This was an investigation of the effects of subliminally presented drive related stimuli on the cognitive performance of 30 hospitalized schizophrenics. Subjects were seen individually for three sessions in a balanced design. In each session, an assessment was made of the effects of an aggressive, libidinal, or neutral stimulus on performance in tests of arithmetic, similarities, and picture arrangement (patterned after parts of the Wechsler Intelligence Scales). Assessments were made of ego pathology and cognitive deficit and the effects of the drive conditions were compared with those of the neutral condition. The results obtained support the views that: (a) the stimulation of drive derivatives in schizophrenics exacerbates aspects of their ego impairment; (b) the method described allows for the experimental study of the effects of drive activation on ego functioning.

THE HALLUCINATORY EXPERIENCE: AN ATTEMPT AT A PSYCHODYNAMIC CLASSIFICATION AND RECONSIDERATION OF ITS DIAGNOSTIC SIGNIFICANCE

Experiences gained in clinic in Central Harlem area, population of which consists largely of Negro (90-95%) and Puerto Rican (5-10%) children from six months through fifteen years of age from low socioeconomic group, drew attention to fact that in one year and half, forty-two children were seen with hallucinatory phenomena who did not give indication of psychotic or schizophrenic process. Diagnostically these children fell in same categories as those without hallucinatory experiences and socially shared common sources of deprivation. The diagnoses used were those in Diagnostic Manual of American Psychiatric Association; diagnosis of schizophrenic reaction was reserved for severely ill children where quantity and quality of disturbance in ego function served as chief criteria in making this diagnosis. Hallucinatory experience, except perhaps in pediatric age group, has been seen as part of schizophrenic symptomatology in spite of recent interest in eidetic and hypnagogic imagery. As part of schizophrenic process it has been taken as evidence of complete break with reality in patient with severe ego pathology. Its basic definition is of a perception without corresponding stimuli from outside, while Freud (1917) proposes that the hallucination consists in cathexis of system conscious (perception) which however does not proceed as normally from without but from within,

A Theory of EGO Pathology and EGO Therapy

A Theory of EGO Pathology and EGO Therapy