Schizophrenia Research Trends

Body Image Deviation in Chronic Schizophrenia: New Research 3Twemlow et al., 1982), dysmorphophobia (Connolly & Gipson, 1978; Hay, 1983; Birtchnell,1988; Snaith, 1992; Philips & McEloroy, 1993; deLeon et al., 1989; Phillips et al., 1994), andself-injury or self mutilation (Feldman, 1988; Burgess, 1991; Martin & Gattaz, 1991;Sonneburn & Vanstraelen, 1992; Weiser et al., 1993; Kennedy & Feldmann, 1994). Inaddition, the effects of body-oriented psychotherapy have been suggested (Darby, 1968;Berman, 1972).According to Roehricht and Priebe (1997) in a report by Huber and Zerbin-Rueden(1979), although symptoms relevant to body distortion were seen in more than 74% of casesof schizophrenia, little attention has been paid to the evaluation of such symptoms. Thesesymptoms are not included as a prominent component in psychometric approaches tomeasuring symptoms, such as the Brief Psychiatric Rating Scale, BPRS, (Overall & Gorham,1962) or the Positive and Negative Symptoms Scale, PANSS (Kay et al., 1987). It is,however, not fair to regard that the issue as being rather neglected. Specifically, bizarresomatopsychic phenomena, e.g., feelings that the body is "being radiated," "being controlledby others," and "being cut up" have been reported in schizophrenia. Some of these abnormalbody perceptions have been designated as "Schneiderian first rank symptoms" (Schneider,1959/1976). Dysmorphophobia was relabeled as “one of the Somatoform Disorders” in 1980.“Body Dysmorphic Disorder,” and its counterpart, “Delusional Disorder, Somatic Subtype”in 1987, were included in the Diagnostic and Statistical Manual of Mental Disorders(American Psychiatric Association, 1987), which produced considerable concern overdelusions regarding appearance of the body (deLeon et al., 1989; Phillips et al., 1994). First,studies of these symptoms relevant to disturbances in body experiences in schizophrenia arereviewed to give an overview of how the problems have been described and treated.Before AntipsychoticsEven in the era before antipsychotic agents, body image was rather attractive to thosewho studied the psychopathology of schizophrenia. Since Wernicke foreshadowed the idea ofbody image in his concept of "somatopsyche," this whole psychological field has beenrecognized as important in the understanding of psychotic patients, especially in relation tohallucinatory and delusional disturbances (Schilder, 1935; Angyal, 1936; Gerstmann, 1942;Bychowsky,1943).The initial study of body image was a description of phantom limb. It was succeeded byneurological research from the 1910s to the 1950s (Head, 1911/1926; Pick, 1922; Schilder,1935), and body image was conceived as the equivalent of "body schema" or "posturalschema." This became the traditional definition of the concept. It was introduced to the fieldof psychiatry by Schilder (1935), and attempts were made to find similar distortions inpsychiatric patients (Schilder, 1935; Angyal, 1936).Bodily Hallucination and Somatic DelusionLukianowicz (1967) and McGlichrist and Cutting (1995) classified somatic delusions ofpsychotic cases including schizophrenia, showing that bodily delusions and hallucinationsoccur mostly inseparably. Bodily hallucination and somatic delusion have been treated ascoenaesthesis in non-English speaking psychiatry, especially in Germany, where it was often