Psychosis and the self: How spontaneous discussions of subjective experiences compare in the clinical high-risk and first-episode psychosis populations.

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Abstract
Prior qualitative studies show that individuals with psychoticlike experiences express difficulties concerning their identity. However, previous work has studied individuals at clinical high risk for psychosis (CHR) and individuals with first-episode psychosis (FEP) separately. Here, we compare the experiences of individuals at CHR, individuals with FEP, and healthy individuals. Participants included 70 individuals at CHR (57% female, Mage = 19.2 ± 3.0), 50 individuals with FEP (56% female, Mage = 20.4 ± 2.9), and 70 healthy individuals (67% female, Mage = 21.1 ± 2.8). Participants completed 30-45-min open-ended interviews. Trained research staff reviewed interview transcripts and conducted an iterative thematic analysis to identify major themes. Themes related to distress, social difficulties, trauma, gratitude, and communication were spontaneously described by both individuals at CHR and individuals with FEP, with individuals at CHR describing suspiciousness more than individuals with FEP (42% vs. 22%), χ²(1, 120) = 4.95, p = .03, and individuals with FEP discussing adaptive integration of mental health struggles into their identity more than individuals at CHR (56% vs. 36%), χ²(1, 120) = 4.87, p = .03. Healthy individuals endorsed future orientation more than individuals at CHR (69% vs. 49%), χ²(1, 140) = 5.77, p = .02, and individuals with FEP (69% vs. 48%) χ²(1, 120) = 5.14, p = .02. All groups endorsed essentialist beliefs: CHR (31%), FEP (43%), and healthy controls (44%). Individuals at CHR and with FEP spontaneously discuss issues related to their identities in ways that are informed and shaped by the social milieu. The bidirectional nature of these struggles reinforces a need for integrated care through psychiatric rehabilitation, with a specific focus on identity development. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Funding Information
  • National Institutes of Health (R01MH115332)

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