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Auerbach, J.S. Blatt, S.J. (1996). Self-Representation in Severe Psychopathology: The Role of Reflexive Self-Awareness. Psychoanal. Psychol., 13(3):297-341.

(1996). Psychoanalytic Psychology, 13(3):297-341

Self-Representation in Severe Psychopathology: The Role of Reflexive Self-Awareness

John S. Auerbach, Ph.D. and Sidney J. Blatt, Ph.D.

In both normal and abnormal functioning, the self is a complex psychological structure that is constituted and experientially divided by reflexive self-awareness—by the tension that arises from coordinating subjective and objective perspectives on the self. Disturbances in reflexive self-awareness are central to the development of severe psychopathology. Although both schizophrenia and borderline personality disturbances involve difficulties in self-reflexivity, schizophrenia also involves a more fundamental disturbance in the core, embodied self. In a sample of 40 adolescent and young adult psychiatric inpatients, qualitative analyses of spontaneous self-descriptions revealed that, among schizophrenic persons, reflexive self-awareness usually results in confusion and perplexity, as if a sense of identity were lacking altogether. Among borderline patients, who have tenuously established a core self, a sense of identity is present but is unstable and highly reactive to changes in mood. These impairments in self-reflexivity likely result from multiple developmental deviations over the course of childhood and adolescence. Intensive analyses of the spontaneous self-descriptions of two schizophrenic patients and two borderline patients illustrate these findings.

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