Reconciling the Ipseity-Disturbance Model with the Presence of Painful Affect in Schizophrenia

Contemporary phenomenological analyses have offered rich descriptions of schizophrenia. A prominent phenomenological model, the ipseity-disturbance model, has described forms of self-disturbance that contribute to characterizations of schizophrenia largely in terms of alterations in thoughts and perception. Other descriptions of schizophrenia, however, including classic psychiatry texts, psychoanalytic writings, first-person accounts, and emerging neuroscience findings, have suggested that deeply painful affective states are essential aspects of the experience of the disorder. In this paper, we seek to reconcile this seeming contradiction by proposing several integrative models. Specifically, we address this question by review of the treatment of painful affect within the ipseity-disturbance model, followed by a review of a range of other accounts in which painful affect is emphasized. This review suggests that an integrative approach offers opportunities for viewing phenomenological accounts of schizophrenia in concert with others that more centrally emphasize painful affect.