Role of the self in schizophrenia: a multidimensional examination of short-term outcomes

The manifestation, course, and prognosis of schizophrenia are extremely variable, raising an interest in the role of personality and self-concept in the illness' outcome. Building on voluminous research attesting to the fragility and instability of the self in schizophrenia, we examined the role of four self-concept aspects--self-esteem level, self-esteem instability, self-concept clarity, and the perception of the self as ill--in schizophrenia-spectrum disorders. Eighty-nine outpatients were assessed at baseline, and five days subsequently, regarding these self-concept aspects, symptoms, stress, and quality of life. Six weeks later, participants were again assessed using the baseline battery. Self-esteem instability predicted a decrease in quality of life over the study period. Self-concept clarity predicted an increase in quality of life and in positive symptoms, particularly under low stress. Depressive symptoms predicted a decrease in self-esteem levels and an increase in the perception of the self as ill. Thus, all four self-concept aspects were shown to be pertinent to the experience of schizophrenia, albeit in different ways. Special attention should be directed to self-concept clarity, which embeds both risk and resilience.