Differentiation of Self and Social Functioning in Severe Mental Disorders

Differentiation of self, which is understood to be the psychological individuation of a person from their parental figures, is considered a key factor in the origin of severe psychopathology. In this study, we aim to explore the ways in which the process of differentiation of self develops in people with various severe mental disorders, examining its impact on social functioning together with diagnosis, current symptoms, illness variables, and sociodemographic features. One hundred thirty patients (45 diagnosed with schizophrenia, 44 with bipolar disorder, and 41 with major depressive disorder) and 45 controls were assessed using the Differentiation of Self-Inventory-Revised, the Family of Origin Scale, the 90 Symptom Check List-Revised, and the Social Adaptation Self-Evaluation Scale. As for differentiation of self, patients showed lower I-position and poorer emotional reactivity than controls. Additionally, emotional reactivity was poorer for patients with schizophrenia and bipolar disorder than for those with major depressive disorder; and a poor emotional cutoff (remoteness) was evidenced only in schizophrenia. Individuals with schizophrenia and bipolar disorder had lower capacity for differentiation than controls, and those with schizophrenia were less differentiated than those with major depressive disorders. Among the main predictors of poor social functioning were low differentiation of self and low differentiation from the family of origin rather than any specific clinical diagnosis. These findings suggest a possible utility of using the concept of differentiation of self as a psychological marker to classify severe mental disorders. Critically, social functioning may improve with interventions focused on differentiation of self. 自我分化,被理解为一个人从父母形象中分离出来的心理个体化,被认为是严重精神病理起源的关键因素。在这项研究中,我们旨在探索各种严重精神障碍患者自我分化过程的发展方式,研究其对社会功能、诊断、当前症状、疾病变量以及社会人口特征的影响。使用自我分化修订量表、原生家庭量表、90症状清单和社会适应自我评估量表,对130例患者(45例诊断为精神分裂症、44例诊断为双相情感障碍、41例诊断为重度抑郁障碍)和45例对照组进行了评估。对于自我分化,患者表现出比对照组更低的I位和较差的情绪反应性。此外,精神分裂症和双相情感障碍患者的情绪反应性比重度抑郁障碍患者差。而糟糕的情绪阻断(远离)仅在精神分裂症中得到证实。精神分裂症和双相情感障碍患者的分化能力低于对照组,精神分裂症患者的分化程度低于重度抑郁症患者。社会功能不良的主要预测因素包括自我分化低以及与原生家庭分化低,而非任何特定的临床诊断。这些发现表明,使用自我分化的概念作为心理标志物对严重精神障碍进行分类的可能效用。至关重要的是,通过着重于自我分化的干预措施,社会功能可能会得到改善。