The body as terra incognita – cenesthopathy in schizophrenia

Cenesthopathy, a subclinical symptom of schizophrenia, often appears years before full-blown psychosis. The paper outlines the role of normative cenesthesia and its disruptions in self-regulation processes, the differentiation of mental representations, and identity, all structured within the model of the bodily self. Although bizarre bodily sensations are present in various psychiatric and somatic illnesses, the analysis of the narratives makes it possible to distinguish schizophrenia-specific characteristics of cenesthopathy, such as difficulty verbalising sensations and identifying their causes, their uncanny and enigmatic nature, problems coping with these sensations, and their catastrophic interpretation. Empirical evidence confirms the association of cenesthopathy with disturbances in subsystems of the bodily self, including the interpretation and regulation of bodily states, body representations, and identity. Thus, the presence of cenesthopathic sensations in schizophrenia disrupts the differentiation of stable representations of bodily states and characteristics, resulting in the disintegration of identity. This disintegration is associated with a state of disorientation, anxiety, and a sense of detachment from one’s own body. The conceptualisation of cenesthopathy in schizophrenia in relation to disembodiment and disruptions of the bodily self leads to the following practical conclusions: 1) interview-based assessment of cenesthopathy is useful for diagnosing the prodrome of schizophrenia; 2) caution is advised regarding techniques that enhance bodily awareness; 3) enhancing self-representations and identity processes in therapy helps mitigate the alienation caused by cenesthetic sensations; and 4) self-diagnoses, whose function is to attribute meaning to bodily sensations, should not be dismissed, even if they appear surprising to the clinician.