Abstract
Background: In recent times, adolescents with severe forms of psychopathology that do not unambiguously fit into a precise diagnostic category have come to clinical observation. The diagnoses attributed to these young patients range from borderline personality disorder, to affective disorders, ADHD, and others. These diagnoses are mainly based on behavioural abnormalities (e.g., social withdrawal, aggressiveness, self-injuring behaviour), but fail to capture the experiential core of their suffering. Summary: Research in psychopathology, particularly that with a phenomenological approach, has long been committed to identifying early markers of schizophrenia in clinical pictures that precede the full onset of this pathology. In this paper, two case studies in transitional age youth (TAY) and additional material taken from our own clinical practice are presented where self-disorders and anomalies of common sense – originally developed to phenomenologically characterise the schizophrenic spectrum phenotype, and especially non-delusional forms of schizophrenia – are used to complement standard nosographic assessments. Key Message: We propose that using some of these phenomenological constructs can shed light on certain TAY pictures, in particular the most serious ones, helping us grasp their psychopathological core, and provide further elements for a fine-grained characterization and in-depth understanding. We propose as a work-in-progress a set of tentative criteria to differentiate such phenomena in TAY patients as compared to patients with a diagnosis of schizophrenia.
Plain Language Summary
In this manuscript, we address the problem of diagnosing patients with so-called TAY psychopathology. Such patients usually receive heterogeneous and contradictory diagnoses often based on behavioural findings. We propose to adopt some phenomenological constructs as a guide for understanding and framing some of these cases. Specifically, common-sense disorders, intersubjective attunement disorders, self-disorders, and existential reorientation. Although we recognise the importance of these phenomena as markers of schizophrenia, we do not propose to consider them as such in this patient population, who present a more nuanced symptomatology and a more fluid evolution than their peers with schizophrenia. Rather, we propose using these phenomena – not as diagnostic indices, but as pointers in the direction of a better understanding of these severe non-psychotic adolescent psychopathological forms. Two clinical cases are presented to demonstrate the necessity of including the subjective experience of these young patients in order to understand their condition. Therefore, an effort is made to capture differences, understand reasons, and link them to behavioural symptoms that have emerged.
