[The psychopathology of ego disturbances: history and phenomenology]

Insight and Dissociation in Lucid Dreaming and Psychosis

Dreams and psychosis share several important features regarding symptoms and underlying neurobiology, which is helpful in constructing a testable model of, for example, schizophrenia and delirium. The purpose of the present communication is to discuss two major concepts in dreaming and psychosis that have received much attention in the recent literature: insight and dissociation. Both phenomena are considered functions of higher order consciousness because they involve metacognition in the form of reflective thought and attempted control of negative emotional impact. Insight in dreams is a core criterion for lucid dreams. Lucid dreams are usually accompanied by attempts to control the dream plot and dissociative elements akin to depersonalization and derealization. These concepts are also relevant in psychotic illness. Whereas insightfulness can be considered innocuous in lucid dreaming and even advantageous in psychosis, the concept of dissociation is still unresolved. The present review compares correlates and functions of insight and dissociation in lucid dreaming and psychosis. This is helpful in understanding the two concepts with regard to psychological function as well as neurophysiology.

[On the differential diagnostics of depersonalization experiences]

Depersonalization represents an unspecific symptom which is to be found across the entire spectrum of psychiatric nosology. Delineating the historical lines of development of the depersonalization concept and reviewing existing psychopathological experiential knowledge reveals that depersonalization is underpinned by highly diverse modes of experience. In terms of differential diagnostics at the symptom level, a distinction can be made between depersonalization as a neurotic phenomenon on the one hand and a psychotic form occurring in schizophrenia and melancholia on the other. The reference points defined here extend beyond current descriptive classifications and open up the diagnostic process to allow an inclusion of etiological and therapeutic aspects.