Felt presence: paranoid delusion or hallucinatory social imagery?

Felt presence and its determinants in young adults: results from three independent samples

Felt presence (FP) is a phenomenon that might appear in individuals with mental and neurological disorders as well as those without any specific morbidity. Some studies have indicated that FP is closely related to psychotic symptomatology. Yet, the mechanisms underlying its occurrence remain largely unknown. The present study aimed to disentangle as to whether FP is associated with widely known risk factors of psychosis. Data from three independent samples of non-clinical young adults were analyzed. Self-reports were administered to assess psychopathological symptoms (samples 1 - 3), neurodevelopmental risk factors for psychosis (sample 1), social defeat components (sample 2), childhood trauma and loneliness (sample 3). A total of 4782 individuals were surveyed across all three samples. Unadjusted analyses showed that the following factors are associated with higher odds of FP: obstetric complications, childhood trauma, non-right handedness, a lower education level, unemployment, minority status, humiliation, perceived constraints, and loneliness. However, only minority status and a lower level of education were associated with higher odds of FP after adjustment for other psychopathological symptoms, age, and gender. Importantly, hallucination-like experiences across all recorded modalities and paranoia were associated with higher odds of FP in all samples. Depressive symptoms were weakly associated with FP in two samples. Findings from the present study suggest that the majority of known risk factors for psychosis contribute to the emergence of FP through the effects on psychotic experiences. Low educational attainment and minority status might be the only risk factors independently contributing to the emergence of FP.

Varieties of felt presence? Three surveys of presence phenomena and their relations to psychopathology

BACKGROUND

Experiences of felt presence (FP) are well documented in neurology, neuropsychology and bereavement research, but systematic research in relation to psychopathology is limited. FP is a feature of sensorimotor disruption in psychosis, hypnagogic experiences, solo pursuits and spiritual encounters, but research comparing these phenomena remains rare. A comparative approach to the phenomenology of FP has the potential to identify shared and unique processes underlying the experience across these contexts, with implications for clinical understanding and intervention.

METHODS

We present a mixed-methods analysis from three online surveys comparing FP across three diverse contexts: a population sample which included people with experience of psychosis and voice-hearing (study 1, N = 75), people with spiritual and spiritualist beliefs (study 2, N = 47) and practitioners of endurance/solo pursuits (study 3, N = 84). Participants were asked to provide descriptions of their FP experiences and completed questionnaires on FP frequency, hallucinatory experiences, dissociation, paranoia, social inner speech and sleep. Data and code for the study are available via OSF.

RESULTS

Hierarchical linear regression analysis indicated that FP frequency was predicted by a general tendency to experience hallucinations in all three studies, although paranoia and gender (female > male) were also significant predictors in sample 1. Qualitative analysis highlighted shared and diverging phenomenology of FP experiences across the three studies, including a role for immersive states in FP.

CONCLUSIONS

These data combine to provide the first picture of the potential shared mechanisms underlying different accounts of FP, supporting a unitary model of the experience.

The felt-presence experience: from cognition to the clinic

The felt presence experience is the basic feeling that someone else is present in the immediate environment, without clear sensory evidence. Ranging from benevolent to distressing, personified to ambiguous, felt presence has been observed in neurological case studies and within psychosis and paranoia, associated with sleep paralysis and anxiety, and recorded within endurance sports and spiritualist communities. In this Review, we summarise the philosophical, phenomenological, clinical, and non-clinical correlates of felt presence, as well as current approaches that use psychometric, cognitive, and neurophysiological methods. We present current mechanistic explanations for felt presence, suggest a unifying cognitive framework for the phenomenon, and discuss outstanding questions for the field. Felt presence offers a sublime opportunity to understand the cognitive neuroscience of own-body awareness and social agency detection, as an intuitive, but poorly understood, experience in health and disorder.

Beliefs about sleep paralysis in Turkey: Karabasan attack

The present study examined explanations of sleep paralysis (SP) in Turkey. The participants were 59 college students recruited in İstanbul, Turkey, who had experienced SP at least once in their lifetime. Participants were administered the Sleep Paralysis Experiences and Phenomenology Questionnaire (SP-EPQ) in an interview. When asked whether they had heard of a name for SP, the vast majority (88%) mentioned the "Karabasan"-a spirit-like creature rooted in Turkish folk tradition. Seventeen percent of the participants believed that their SP might have been caused by this supernatural creature. Thirty-seven percent of participants applied various supernatural and religious methods to prevent future SP attacks such as dua (supplicating to God), reciting the Quran, and wearing a musqa (a type of talisman inscribed with Quranic verses). Case studies are presented to illustrate these findings. The Karabasan constitutes a culturally specific, supernatural interpretation of the phenomenology of SP in Turkey.

Sleep paralysis in Italy: Frequency, hallucinatory experiences, and other features

Previous research has found supernatural beliefs about sleep paralysis (SP) to be very prevalent in Italy, with over one third of SP sufferers believing that their SP might have been caused by a supernatural creature known locally as the Pandafeche. The current study further examined features of SP in Italy. All participants had experienced SP at least once in their lifetime. Participants were recruited from the general population (N =  67) in the region of Abruzzo. The Sleep Paralysis Experiences and Phenomenology Questionnaire (SP-EPQ) was orally administered to participants. As hypothesized, we found that Italians from the general population reported high lifetime rates of SP, prolonged duration of immobility during the event, and great fear of the experience (with as many as 42% of SP sufferers fearing that they could die from the experience), all of which were particularly elevated as compared to cultures where there are no such elaborate traditions of SP (e.g., Denmark). In addition, 78% of participants experienced some type of hallucination during their SP. The results we present here suggest that cultural beliefs about SP in Italy (e.g., as being caused by the Pandafeche, as reported elsewhere) potentially can profoundly shape certain aspects of the experience - a type of mind-body interaction.

How deep is the rift between conscious states in sleep and wakefulness? Spontaneous experience over the sleep-wake cycle

Whether we are awake or asleep is believed to mark a sharp divide between the types of conscious states we undergo in either behavioural state. Consciousness in sleep is often equated with dreaming and thought to be characteristically different from waking consciousness. Conversely, recent research shows that we spend a substantial amount of our waking lives mind wandering, or lost in spontaneous thoughts. Dreaming has been described as intensified mind wandering, suggesting that there is a continuum of spontaneous experience that reaches from waking into sleep. This challenges how we conceive of the behavioural states of sleep and wakefulness in relation to conscious states. I propose a conceptual framework that distinguishes different subtypes of spontaneous thoughts and experiences independently of their occurrence in sleep or waking. I apply this framework to selected findings from dream and mind-wandering research. I argue that to assess the relationship between spontaneous thoughts and experiences and the behavioural states of sleep and wakefulness, we need to look beyond dreams to consider kinds of sleep-related experience that qualify as dreamless. I conclude that if we consider the entire range of spontaneous thoughts and experiences, there appears to be variation in subtypes both within as well as across behavioural states. Whether we are sleeping or waking does not appear to strongly constrain which subtypes of spontaneous thoughts and experiences we undergo in those states. This challenges the conventional and coarse-grained distinction between sleep and waking and their putative relation to conscious states. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Presence phenomena in parkinsonian disorders: Phenomenology and neuropsychological correlates

INTRODUCTION

The feeling of a presence that occurs in the absence of objectively identifiable stimuli is common in parkinsonian disorders. Although previously considered benign and insignificant, recent evidence suggests that presence phenomena may act as the gateway to more severe hallucinations and dementia. Despite this, we still know relatively little about these phenomena.

OBJECTIVE

To examine parkinsonian disorder patients' subjective experience of presence phenomena, and retrospectively analyse their cognitive correlates, in order to elucidate the emergence of information processing deficits in parkinsonian disorders.

METHODS/DESIGN

25 patients who endorsed presence phenomena were asked to complete a semi-structured interview about their experiences. The cognitive profiles of these patients were then compared to those of age- and education-matched patients who denied presence phenomena.

RESULTS

Patients described the presence as mostly that of an unknown human with neutral valence. Patients who described it as unpleasant were noted to also demonstrate elevated anxiety. Patients who identified the presence as a known person, described it as touching them, or interacted with the presence emotionally or physically demonstrated reduced insight. Patients with presence phenomena demonstrated more frequent impairments in visual processing, executive function and speed of processing.

CONCLUSIONS

Presence phenomena occur in the company of advancing cognitive impairment and involvement of the posterior cortical functions. Initially encountered as a neutral spatial skeleton, the experience is then shaped by the patient's affective state and level of insight.

Can a microdynamic approach to sleep-onset imagery solve the overabundance problem of dreaming? Commentary on Tore Nielsen's "Microdream neurophenomenology"

Nielsen proposes that a microdynamic approach to experiences occurring in the earliest stages of sleep onset, which he calls microdreams, can shed light on the process of dream imagery formation. I discuss microdreams in the context of simulation views, in which dreaming is defined as the immersive experience of a virtual world centered on a virtual self. I also evaluate his proposal to expand the dimensions included in the oneiragogic spectrum by kinesis. I conclude that while a subset of microdreams might not fulfill the conditions to count as even minimal dreams, their investigation can nonetheless help address key questions in dream research and may even constitute a distinctive pathway to the generation of full-fledged dreaming.

How many bereaved people hallucinate about their loved one? A systematic review and meta-analysis of bereavement hallucinations

BACKGROUND

Bereavement hallucinations (BHs) entail a perception of a deceased in any sense modality or as a quasi-sensory sense of presence. BHs are an associated feature of the proposed Persistent Complex Bereavement Disorder (PCBD) in DSM-5. The goals of this review are to estimate the prevalence of BHs, identify possible moderators, and review the methodological status of this research field.

METHODS

A systematic literature search was conducted through the databases PubMed, PsycINFO, and CINAHL. Studies systematically assessing the prevalence of BHs of a relative or friend were included.

RESULTS

Twenty-one eligible studies were identified and 8 meta-analyses of BHs in different sense modalities were conducted. The prevalence of having one or more BHs was estimated to be 56.6% (95% CI 49.9-63.2), and the estimated prevalence of BHs in specific sense modalities ranged within 7.0-39.7%. Meta-regression analyses revealed associations to age and conjugal bereavement, but results are tentative and dependent on the type of BH in question.

LIMITATIONS

The included studies were methodologically heterogeneous. Limitations included the lack of a valid measure of BHs and low sample generalizability.

CONCLUSION

This first systematic review and meta-analysis of BHs suggests that more than half of the bereaved people experience some kind of BH. However, there are considerable methodological limitations in the research of BHs, which is of pertinent interest as BHs have been linked to the development of a future diagnosis of clinically impairing grief. A valid measure of BHs needs to be developed and used in high-quality epidemiological research using population-based designs.

The Sensed Presence Questionnaire (SenPQ): initial psychometric validation of a measure of the "Sensed Presence" experience

Background

The experience of ‘sensed presence’—a feeling or sense that another entity, individual or being is present despite no clear sensory or perceptual evidence—is known to occur in the general population, appears more frequently in religious or spiritual contexts, and seems to be prominent in certain psychiatric or neurological conditions and may reflect specific functions of social cognition or body-image representation systems in the brain. Previous research has relied on ad-hoc measures of the experience and no specific psychometric scale to measure the experience exists to date.

Methods

Based on phenomenological description in the literature, we created the 16-item Sensed Presence Questionnaire (SenPQ). We recruited participants from (i) a general population sample, and; (ii) a sample including specific selection for religious affiliation, to complete the SenPQ and additional measures of well-being, schizotypy, social anxiety, social imagery, and spiritual experience. We completed an analysis to test internal reliability, the ability of the SenPQ to distinguish between religious and non-religious participants, and whether the SenPQ was specifically related to positive schizotypical experiences and social imagery. A factor analysis was also conducted to examine underlying latent variables.

Results

The SenPQ was found to be reliable and valid, with religious participants significantly endorsing more items than non-religious participants, and the scale showing a selective relationship with construct relevant measures. Principal components analysis indicates two potential underlying factors interpreted as reflecting ‘benign’ and ‘malign’ sensed presence experiences.

Discussion

The SenPQ appears to be a reliable and valid measure of sensed presence experience although further validation in neurological and psychiatric conditions is warranted.

The prevalence and characteristics of hallucinations, delusions and minor phenomena in a non-demented population sample aged 60 years and over

OBJECTIVE

Psychotic phenomena can occur in non-clinical subjects. The goals of this study were to assess the prevalence of delusions, hallucinations and minor 'psychotic' phenomena (visual illusions, feeling of presence and passage hallucinations) and to describe the characteristics of the latter in a non-clinical older population.

METHODS

Three hundred and thirteen individuals aged 60 years and older, without cognitive deficits (according to mini-mental state examination scores) or patent psychotic disease, answered a structured questionnaire focusing on delusions, hallucinations and minor phenomena that they had experienced in the previous month. The study sample was stratified by age and gender according to French demographic characteristics.

RESULTS

Twenty per cent of participants reported one or more psychotic phenomena. These subjects did not differ from those without psychotic symptoms as regards their age, mini-mental state examination scores or education. Minor phenomena were the most common (13%). Hallucinations, in any sensory modality, occurred in 9% of participants. No verbal auditory hallucinations or delusions were reported. The prevalence of minor phenomena increased with age and was associated with the use of psychoactive drugs.

CONCLUSION

By extending the spectrum of psychotic symptoms to minor phenomena, we found that psychotic symptoms were common in a non-clinical older population. Whether the increasing prevalence of minor phenomena with age is due to prodromal neurodegenerative disease or to other factors remains to be investigated. Copyright © 2016 John Wiley & Sons, Ltd.

Post-bereavement hallucinatory experiences: A critical overview of population and clinical studies

BACKGROUND

Removal of the "bereavement exclusion" criterion for major depression and proposed research criteria for persistent complex bereavement disorder in DSM-V pose new compelling issues regarding the adequacy of current nosographical boundaries. Post-bereavement hallucinatory experiences (PBHE) are abnormal sensory experiences that are frequently reported by bereaved individuals without a history of mental disorder. Given current uncertainty over the continuum of psychotic experiences in the general population, whether or not they should be considered pathological remains unclear.

METHODS

In order to systemize available knowledge, we reviewed the literature describing general population and clinical studies on PBHEs. Given the relatively low number of articles, all peer-reviewed, published studies in English were included. No study characteristics or publication date restrictions were imposed.

RESULTS

Overall, evidence suggests a strikingly high prevalence of PBHEs - ranging from 30% to 60% - among widowed subjects, giving consistence and legitimacy to these phenomena.

LIMITATIONS

Whereas general population studies had adequate sample size numbers, all studies in the bereaved population had a very small number of subjects. No consensus for method of evaluation exists in the literature, with some studies using a free interview method and others using semi-structured interviews.

CONCLUSIONS

The available literature appears to support an elevated frequency of PBHEs in bereaved individuals, but further research is needed to increase the reliability of these findings and refine the boundaries between physiological and pathological experiences.

Nightmare frequency is related to a propensity for mirror behaviors

We previously reported that college students who indicated engaging in frequent dream-enacting behaviors also scored high on a new measure of mirror behaviors, which is the propensity to imitate another person's emotions or actions. Since dream-enacting behaviors are frequently the culmination of nightmares, one explanation for the observed relationship is that individuals who frequently display mirror behaviors are also prone to nightmares. We used the Mirror Behavior Questionnaire (MBQ) and self-reported frequencies of nightmares to assess this possibility. A sample of 480 students, consisting of 188 males (19.2±1.73 years) and 292 females (19.0±1.55 years) enrolled in a first-year university psychology course, participated for course credit. They completed a battery of questionnaires that included the 16-item MBQ, plus an item about nightmare frequency (NMF) in the past 30 days. NMF scores were split to create low, medium, and high NMF groups. MBQ total scores were significantly higher for female than for male subjects, but an interaction revealed that this was true only for Hi-NMF subjects. MBQ Factor 4, Motor Skill Imitation, paralleled this global interaction for females, whereas MBQ Factor 3, Sleepiness/Anger Contagion, was elevated only for Hi-NMF males. Item analyses indicated that Hi- and Med-NMF females scored higher than Lo-NMF females on the 3 items of Factor 4 that reflect voluntary imitation (imitating famous/cartoon voices, being a physically active spectator, and learning new skills by observing), as well as on 2 other items that reflect involuntary imitation (contagious yawning and self-rated empathy). Although Hi- and Lo-NMF males differed most clearly on the sleepiness item of Factor 3, all 3 items on this factor (including anger contagion and contagious yawning) are plausibly associated with perception of and response to social threat. Results provide evidence that among females nightmares are associated with voluntary and involuntary mirror behaviors during wakefulness, while among males nightmares are associated with threat-related mirror behaviors during wakefulness. They thus support the possibility that the association between mirror behaviors and dream-enacting behaviors is due to a common mirror neuron mechanism that underlies mirror behaviors and nightmares and that involves motor, rather than emotional, resonance. These results have implications for understanding the comorbidity of nightmares and other pathological symptoms such as imitative suicidal behaviors, the influence of observational learning on dissociative symptomatology, and the predominance of threat and aggression in the dream enacting behaviors of REM sleep behavior disorder.

Relationships between non-pathological dream-enactment and mirror behaviors

Dream-enacting behaviors (DEBs) are behavioral expressions of forceful dream images often occurring during sleep-to-wakefulness transitions. We propose that DEBs reflect brain activity underlying social cognition, in particular, motor-affective resonance generated by the mirror neuron system. We developed a Mirror Behavior Questionnaire (MBQ) to assess some dimensions of mirror behaviors and investigated relationships between MBQ scores and DEBs in a large of university undergraduate cohort. MBQ scores were normally distributed and described by a four-factor structure (Empathy/Emotional Contagion, Behavioral Imitation, Sleepiness/Anger Contagion, Motor Skill Imitation). DEB scores correlated positively with MBQ total and factor scores even with social desirability, somnambulism and somniloquy controlled. Emotion-specific DEB items correlated with corresponding emotion-specific MBQ items, especially crying and smiling. Results provide preliminary evidence for cross-state relationships between propensities for dream-enacting and mirror behaviors--especially behaviors involving motor-affective resonance--and our suggestion that motor-affective resonance mediates dream-enactment imagery during sleep and emotional empathy during waking.

Feeling of presence in Parkinson's disease

BACKGROUND

A feeling of presence (FP), that is, the vivid sensation that somebody (distinct from oneself) is present nearby, is commonly reported by patients with Parkinson's disease (PD), but its phenomenology has not been described precisely. The objective of this study was to provide a detailed description of FP in PD and to discuss its possible mechanisms.

PATIENTS AND METHODS

The authors studied 52 non-demented PD patients reporting FP in the preceding month (38 consecutive outpatients and 14 inpatients). FP characteristics were recorded with a structured questionnaire. The outpatients with FP were compared with 78 consecutive outpatients without FP.

RESULTS

About half the patients said they recognised the 'identity' of the presence. More than 75% of patients said the FP were not distressing, were short-lasting, were felt beside and/or behind the patient, and occurred while indoors; most patients checked for a real presence, but their insight was generally preserved. In 31% of cases, the patients had an unformed visual hallucination simultaneously with the FP. A higher daily levodopa-equivalent dose and the presence of visual illusions or hallucinations were independently associated with FP.

DISCUSSION

Although FP is not a sensory perception, projection of the sensation into the extrapersonal space, along with the frequent co-occurrence of elementary visual hallucinations and the strong association with visual hallucinations or illusions, supports its hallucinatory nature. FP may be viewed as a 'social' hallucination, involving an area or network specifically activated when a living being is present, independently of any perceptual clue.

Sensed presence as a correlate of sleep paralysis distress, social anxiety and waking state social imagery

Isolated sleep paralysis (ISP) is a common parasomnia characterized by an inability to move or speak and often accompanied by hallucinations of a sensed presence nearby. Recent research has linked ISP, and sensed presence more particularly, with social anxiety and other psychopathologies. The present study used a large sample of respondents to an internet questionnaire (N=193) to test whether these associations are due to a general personality factor, affect distress, which is implicated in nightmare suffering and hypothesized to involve dysfunctional social imagery processes. A new measure, ISP distress, was examined in relation to features of ISP experiences, to self-reported psychopathological diagnosis, to scores on the Leibowitz Social Anxiety Scale and to scores on a new questionnaire subscale assessing social imagery in a variety of waking states. Three main results were found: (1) ISP experiences are only weakly associated with a prior diagnosis of mental disorder, (2) sensed presence during ISP is associated preferentially with ISP distress, and (3) ISP distress is associated with dysfunctional social imagery. A general predisposition to affective distress may influence the distress associated with ISP experiences; overly passive social imagery may, in turn, be implicated in this affect distress influence.