Brain systems supporting the narrative self and psychopathology

Disturbances in the narrative self are implicated across psychiatric disorders, with abnormalities in the neural systems supporting its generation and regulation constituting a transdiagnostic risk factor for mental illness. This review highlights how alterations in these brain systems underlie prevalent clinical features, including diminished, rigid, and sustained negative beliefs within the narrative self. The narrative self is framed as a higher-order construct that emerges from multiple systems, with reward, punishment, and motivational signals biasing which experiences are encoded as self-defining and which self-beliefs are reinforced over time. We discuss recent evidence demonstrating how the narrative self is supported by distributed brain networks in which subcortical inputs from the basal forebrain, habenula and mediodorsal thalamus modulate default mode network activity, with the salience, frontoparietal, cingulo-opercular, and hippocampal-parahippocampal networks regulating how self-beliefs are established or updated. Adolescence is emphasized as a developmental period uniquely vulnerable to disturbances in the formation of a coherent, flexible narrative self, wherein asynchronous subcortical and cortical development and pubertal changes interact to confer risk for diminished and rigid self-beliefs. Belief-updating tasks, hierarchical computational models, and ecological momentary assessment are proposed as approaches to quantify how self-beliefs form and shift across time, linking neural signatures of the narrative self to momentary variability. We propose that treating the narrative self as a primary level of explanation for psychopathology positions it as a testable target for future neuroimaging research, providing a clearer bridge from self-referential cognition to interventions in daily life.