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Self-representation in delusional misidentification and confabulated "others"
Todd E Feinberg1, David Roane1
1Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United States.
Patients with delusional misidentification syndromes (DMS) and confabulation may unconsciously reveal authentic self-referential (SR) information. These SR narratives, though attributed to others, offer insights into neuroanatomy, cognition, and psychological defense mechanisms.
Area of Science:
- Neuropsychology
- Psychiatry
- Cognitive Neuroscience
Background:
- Delusional misidentification syndromes (DMS) and confabulation can involve complex, seemingly false narratives.
- These narratives, particularly those concerning "phantom" persons, may contain authentic, albeit distorted, self-referential (SR) information.
Observation:
- Analysis of 50 clinical cases identified four instances of prominent SR narratives in patients with DMS or confabulation.
- SR narratives were characterized by consistent, repeatable misidentifications or confabulations containing true personal facts, feelings, or motivations attributed to a "double" or "phantom" person.
Findings:
- Four comparison cases without SR aspects were identified for contrast.
- Neuroanatomical and neurocognitive features of SR and non-SR cases were reviewed and compared.
- The role of psychological defense mechanisms in the manifestation of SR narratives was considered.
Implications:
- A model integrating neuroanatomical, neuropsychological, and psychodynamic factors in self-related disorders is proposed.
- Understanding these self-related productions has significant clinical and therapeutic potential for patients with DMS and confabulation.
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