Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis

Henry R Cowan; Dan P McAdams; Leah Ouellet; Courtney M Jones; Vijay A Mittal

doi:10.1093/schbul/sbad142

Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis

Schizophr Bull. 2023 Oct 10:sbad142. doi: 10.1093/schbul/sbad142. Online ahead of print.

Authors

Henry R Cowan¹, Dan P McAdams², Leah Ouellet³, Courtney M Jones², Vijay A Mittal²

Affiliations

¹ Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
² Psychology, Northwestern University, Evanston, IL, USA.
³ Human Development and Social Policy, Northwestern University, Evanston, IL, USA.

PMID: 37816626
DOI: 10.1093/schbul/sbad142

Abstract

Background and hypothesis: Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course.

Study design: Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning.

Study results: CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning.

Conclusions: This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.

Keywords: clinical high risk for psychosis (CHR); developmental; narrative identity; psychotic disorders; self-concept; self-disturbances.

Abstract

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