Introduction: The experience of “sensed presence” or “felt presence” in the absence of “other” has been described as a complex multimodal experience to which meaning is given. Sensed presence (SenP) is a transdiagnostic experience that exists along a continuum that can appear during isolation, spirit quests, exposure to extreme elements, bereavement, anxiety, and psychosis. Given the prevalence and vast heterogeneity of SenP, in addition to a surprising lack of targeted research into this phenomenon, this research examined the interrelationship of SenP, attenuated psychosis symptoms (APS), and transliminality. Transliminality is composed of absorption, fantasy proneness, paranormal belief, mystical experiences, increased creativity, and hyperaesthesia. Methods: A completely anonymous online survey of unusual experiences and mental health was distributed via social media (i.e., Twitter, Facebook, Reddit, and mass emailing lists) to recruit participants. Demographic data were analyzed using χ2 tests and one-way ANOVAs. A two-step cluster analysis was conducted to identify distinct sub-categories of transliminality followed by ANOVAs with bootstrapping at 1,000 iterations to compare SenP, increased APS, and transliminality. Pearson’s bivariate correlations were conducted to determine the association between SenP, APS, and transliminality. Results: Together with descriptive findings, we show distinct characteristics between clusters. T1 cluster consisted of individuals with few SenP experiences, low APS, and low transliminality. T2 consisted of individuals with a moderate prevalence of SenP, low APS, moderate transliminality, and increased overall feeling of closeness to G-d. There was no significant difference in APS between T1 and T2 or in the level of distress associated with APS. T3 individuals showed a significantly higher prevalence of SenP in all domains (frequency, distress, vividness, and total score), higher APS, and higher transliminality, compared to T1 and T2. The T3 cluster met criteria for high risk to develop psychosis. Conclusion: Thus, our findings demonstrate a strong association and entanglement of these experiences which suggests that the interrelatedness of transliminality/absorption and APS may serve as a potentially provocative underlying structure in the phenomenology of SenP.

“It knows that I’m aware of it.”1

Nearly everyone has experienced the feeling of a sensed presence (SenP) at some point despite there being no other person nearby. This feeling may range from vague and indistinct impressions to a feeling of absolute certainty. The experience of “sensed presence” also referred to as “felt presence” in the absence of “other” has been described as a complex multimodal experience to which meaning is given. SenP is a transdiagnostic experience that exists along a continuum that can appear during periods of isolation, exposure to extreme elements (solitary sailing, polar trekking, or mountain climbing), sleep paralysis, bereavement, anxiety, and psychosis [1‒6]. SenP has been reported in environments of spirit quests, deep meditation states, or other religious experiences in which the mystical encounter with the SenP is the cultural norm where the presence is sought after and welcomed [7‒9]. SenP or entity encounters have also been reported in states of drug-induced psychedelic experiences in which the personification of the presence has been described as entities with agency and intentionality [8, 10]. SenP has also been described in contemporary tulpamancy narratives. Tulpamancers are individuals who create imaginary companions known as tulpas through meditative practices that originated in Tibetan Buddhism [11]. Over time, tulpas are experienced as agentive entities that are separate and distinct from self [12]. SenP that accompanies hypnagogic and hypnopompic hallucinations is often described as threatening, malignant, or evil and is often accompanied by bodily sensations eliciting a hypervigilant defensive state [13]. It has been argued that SenP is an “imperfectly developed” hallucination [14]. SenP as a “resident property of the human brain” has been attributed to varied sources such as visitations by G-d, spirits, angels, deceased loved ones, a manifestation or apparition of deities, imagination, or physical sensations [15]. The presence “may appear bizarre by ‘normal’ standards but in fact represent a best fit response to a bizarre environment [16].”

The core phenomenological experience of SenP emerges in the alteration of commonsense and everydayness. Commonsense foregrounds the pre-reflexive axioms of everyday life and the environment or social world that provide a framework of operational shared assumptions that are typically taken for granted [17‒19]. Husserl frames commonsense as “something taken for granted as well as ‘something entirely commonplace’ (ein sehr Selbstverständliches), a fabric of combined senses that cohesively weaves together the interior and exterior world that is centered around the ‘presentness’ of the world that remains as elusive as it stands plainly there in all its obviousness [19].” According to Blankenburg, commonsense exists within the historical, cultural, and social context [17, 20, 21]. Commonsense knowledge would thus operate as a foundation bridging everydayness and a sociologically oriented understanding of being in the world [22]. Bégout identifies four dimensions of the essential framework of everydayness that consists of repetition of daily routines and habits; shared norms and values of a given community; and familiarity with the ability to adjust to unexpected events in a background of neutrality [21, 23]. We hypothesize that alterations in everydayness and commonsense are not exclusive to the psychotic experience and to a varying degree are experienced in nonpsychotic sensory and perceptual anomalous experiences. It is against the backdrop of commonsense and everydayness that SenP breaks through the horizon of consciousness, if even for a moment this framework contracts and then expands in the opening of a new threshold as the individual becomes immersed or absorbed in the aberration; the SenP exists outside of and is distinct from commonsense and everydayness. This in turn restructures the very metaphysical essence of being in the world. Anomalous experiences emerge in the incongruency of background commonsense and everydayness. As in depersonalization and derealization, the phenomenological construct and contours of SenP rest in the temporary suspension of familiarity (Bekanntheitsqualität) and alterations in the perception of space, time, bodily changes, sensory experiences, and alteration in sense of self and the relationship with the environment [24‒27]. To restabilize, meaning with weighted internal reference is given to the SenP that is situated at the threshold of consciousness.

The process of “meaning making” or “meaning given to” anomalous experiences, such as SenP, involves the first-person interpretation of the experience rooted in the person’s unconscious, beliefs, values, culture, and history. Phenomenological models developed by K. Jaspers have referred to this internal dialectical exchange as “position-taking” (Stellungnahme) in addition to the integration of appraisal in such to create “coherence and purpose, prospectively shaping our way of being in the world within a value-laden framework of significance [28‒33].” First-person phenomenological compilations of SenP in psychosis are extremely heterogeneous in terms of rich, complex, multimodal sensory and perceptual experiences and meaning making, “I have experienced 'felt presences', seeing shadowy figures, or feeling disembodied presences, or the touch of a disembodied 'ghost' hand on my body. I have seen figures in my mind's eye or seen them standing over my body.….Sometimes I get the paranoid sense of cameras in the walls and then the felt sense of a disembodied figure in the room watching me or standing behind me or over me, or outside the room behind the window of the house peering in. Sometimes I will see the shadowy figure in the room, or sometimes I 'sense' it [34, 35].” The Hearing Voices Movement has long embraced the importance of meaning making as a fundamental premise in understanding voices and other extreme states within the context of personal history, trauma, and culture in an environment that both acknowledges the distress and impact these experiences may have induced while also promoting acceptance and recovery [36‒40].

The incidence of SenP experiences in bereavement has been reported in approximately 50% of the bereaved population and has been reported in cross-cultural research as a positive experience suggesting that those who can make sense of their experience within a spiritual conceptual framework actually find the SenP beneficial in the grieving process [41]. According to cross-cultural studies of SenP in meaning-making during bereavement it is tied to the cultural setting in which it takes place and is understood [41‒46].

The meaning given to the SenP is rooted in the unconscious of the individual and transliminality may serve as a mechanism bridging unconscious and conscious states. Transliminality is defined as the “tendency for psychological material to cross (trans) thresholds (limines) into or out of consciousness [47‒49].” The transliminality construct is composed of absorption, fantasy proneness, magical ideation, paranormal belief, mystical experiences, and hyperaesthesia (a “hypersensitivity” to environmental stimulation) [50, 51]. High degrees of transliminality have been associated with an openness to mystical experiences, beliefs in paranormal activity, greater creativity, and psychoticism, in addition to increased sensitivity to sensory experiences, including olfactory, visual, auditory, or tactile that can overwhelm the individual [47, 52, 53]. Absorption, as a component of transliminality, has shown to be an underlying precept entangled in psychosis by which the individual experiences increased absorption and immersion in mental imagery or perceptual stimuli when compared to individuals without psychosis [54, 55]. Absorption includes “the capacity for marked restructuring of one’s phenomenal field, especially the sense of self and its boundaries [56].” Absorption has been identified as a key component to “facilitate the experiential involvement that helps to make those immaterial others seem more real [7].” Additionally, increased absorption has been related to psychosis and basic self-disturbances, which are expressed in the dissolution of the boundaries between self and the interior and external worlds. It has been hypothesized that full-fledged hallucinations and delusions are downstream from core alteration of basic self-experience, while increased salience is often reported in conjunction with increased self-disturbance [54, 57]. SenP positions self as “other” causing self to become hyper-aware as an object; “by the mere appearance of the ‘Other,’ I am put in the position of passing judgment on myself as an object, for it is as an object that I appear to the ‘Other’ [58].”

The neurological basis of SenP has long been established from case studies of epilepsy [59‒62], Parkinson’s disease [63], migraine [64], and hypoxia [65]. More recently, neuroimaging and brain stimulation studies have provided evidence for the role of cortical network that includes the temporoparietal junction (TPJ), the insular, and the frontoparietal cortex in SenP [66, 67]. These brain regions are associated with multisensory integration, self-other distinction, and mental imagery involving body schema representation [59, 66‒69]. Abnormal functioning of the TPJ is thought to be involved in the activation of the internal representation of the body schema (postural and kinesthetic) into the extrapersonal space, which is interpreted as an external agent by the patient [59, 67‒69]. Importantly, SenP can be induced by stimulating the TPJ region in humans [66].

Although the evidence for the involvement of the TPJ in SenP is robust, it does not necessarily explain why one would attribute one’s body imagery to an external agent or whether all SenP are related to one’s own body or to imagery-related evocations of others. Current cognitive models of hallucinations and delusions suggest that anomalous and unusual perceptual events necessitate a top-down account to reconcile the discrepancy between observed experience with expected outcomes [70]. In this context, SenP may be understood as a form of social hallucination that arise from anomalous activity of the cortical network involved in body representation, self-processing, and imagery.

Aims of the Study

This current research builds on earlier research in psychosis, absorption, and self in a clinical population by extending the research to the nonclinical population [54, 55, 71]. The primary aim of the study was to examine the role of transliminality [47] as both a mechanism bridging unconscious and conscious states that encompass absorption and attenuated psychosis symptoms (APS) [72] in the experience of SenP.

Participants

A completely anonymous online REDCap [73] survey of unusual experiences and mental health was distributed via social media (i.e., Twitter, Facebook, Reddit, and mass emailing lists) to recruit participants. No identifying information was collected and hence this study received an exempt determination from the Vanderbilt University Institutional Review Board (IRB #212181). For the purposes of the present study, we will be reporting the findings of a subsample of the larger study. This subsample consisted of 131 participants who completed the Sensed Presence Questionnaire, the Prodromal Questionnaire, and the Revised Transliminality Scale.

Measures Used to Assess the Phenomenology of Sense of Presence

The three primary measures applied in this study included the Sensed Presence Questionnaire (SenPQ) [74], the Prodromal Questionnaire (PQ-16) as a measure of APS [72], and the Revised Transliminality Scale (RTS-17) [47]. Descriptive and demographic information and the Daily Spiritual Experience Scale [75] were also collected on all individuals.

The SenPQ was derived from an extensive literature review of SenP phenomenon to reflect the wide range of settings or conditions of occurrence [74]. SenPQ is a 16-item measure that evaluates experiences within the past month using a Likert scale with scores ranging from never (1), occasionally (2), sometimes (3), very often (4), and always (5). Examples included a range of questions designed to measure positive, neutral, and negative valence: “I have felt the presence of a protective being around me that I couldn’t see; even though I knew it was my imagination, I still felt as if someone or something was with me and I have felt a sinister or threatening presence around me, despite not being able to see any evidence for it.” We also included questions designed to evaluate the frequency of the experience, “How often have you had an experience like this?”; level of distress of the experience, “When this happens, I feel frightened, concerned, or it causes problems for me.”; and vividness, “When I had this experience it felt real, vivid, and/or intense.” The measure demonstrated high internal consistency (Cronbach’s alpha = 0.90) with this specific sample.

The Prodromal Questionnaire-16 (PQ-16) is a screening instrument designed to assess symptoms associated with increased risk for psychosis during the prodrome phase [72]. PQ-16 is composed of items scored as either, no (0), or yes (1). If the symptom is endorsed, the individual also evaluates the degree of distress using a 5-point Likert scale ranging from strongly disagree (1), disagree (2), neutral (3), agree (4), and strongly agree (5). Examples of items included “I feel uninterested in the things I used to enjoy” to “I have heard things other people can’t hear like voices of people whispering or talking.” A cutoff of 6 or more symptoms on the PQ-16 has a high positive rate (87%) and high specificity (87%) when differentiating ultra-high risk to developing psychosis [72]. The Cronbach’s alpha was 0.83 for this measure with this specific sample.

The Revised Transliminality Scale (RTS-17) consists of 17 items [50, 51]. Each item was scored on a 5-point Likert scale ranging from strongly disagree (1), disagree (2), neutral (3), agree (4), and strongly agree (5). The RTS-17 was designed to measure the core phenomena of transliminality which consists of beliefs and/or paranormal experiences, mystical experiences, creativity, fleeting manic experiences, magical ideation, high absorption, dream interpretation, and fantasy proneness [51, 52, 76]. More recent studies suggest that transliminality is an expression of neuroplasticity and thus a valid measure of consciousness [77]. For example, questions targeted beliefs, perceptions, immersion, absorption, and consciousness include the following: “At times I perform certain little rituals to ward off negative influences”; “It is sometimes possible for me to be completely immersed in nature or in art and to feel as if my whole state of consciousness has somehow been temporarily altered”; and “I sometimes have a feeling of gaining or losing energy when certain people look at me or touch me.” The Cronbach’s alpha was 0.91 for this measure with this specific sample.

Data Analyses

All data analysis were conducted using SPSS v28. Demographic data were analyzed using χ2 tests and one-way analyses of variance (ANOVAs). For ANOVAs that yielded significant results, Bonferroni post hoc tests were used to identify significant pair-wise group differences. Two-step cluster analyses were conducted to identify distinct sub-categories of transliminality followed by ANOVAs with bootstrapping at 1,000 iterations to compare SenPQ, APS (PQ-16), and transliminality total score. Pearson’s bivariate correlations with bootstrapping at 1,000 iterations were conducted to determine the association between SenP, APS, and transliminality. The magnitude of the correlation was interpreted following Cohen’s recommendation in which 0.10 is small, 0.30 is medium, and 0.50 is large [78, 79]. The correlation matrix for the heatmap was generated using the library packages reshape2 and ggplot2 in R Studio [80, 81]. The heatmap was generated, the variables were reordered, and the coefficients were added using ggplot2.

Descriptive Characteristics

The sample consisted of a total of 131 individuals who completed the SenPQ, PQ-16, and the RTS-17 as part of the larger online mixed-methods survey. To identify specific subtypes, we first conducted a two-step cluster analysis that consisted of preclustering and standard hierarchical clustering algorithm of transliminality items [82, 83]. The analysis yielded three distinct clusters. Cluster 1: low transliminality (T1) consisted of 47 individuals (36%); cluster 2: moderate transliminality (T2) consisted of 33 individuals (25%); and cluster 3: high transliminality (T3) consisted of 51 individuals (39%). The primary cluster predictor algorithm showed that increased mystical experiences (item 18), altered states of consciousness resulting in enlightenment (item 3), and increased perceived responses to other’s “energy” (item 26) were more discrete variables in identifying cluster subtypes, whereas “make-believing and imagining” (item 4) and “performing rituals to ward off negative influences” (item 2) were least predictive.

As shown in Table 1, there were no significant demographic differences between clusters in sex, race, education, employment, history of neurological or seizure disorder, and history of head injury. There was also no significant difference between clusters in age at index and age of most recent experience of SenP. However, individuals in the T3 cluster were significantly younger when they first experienced SenP (p = 0.02) and were significantly more likely to report a history of out-of-body experiences (p = 0.001). There was also a significant difference in the current living situation (p = 0.001), showing that T3 individuals were more likely to live alone. Although there was no significant difference between clusters in the degree of spirituality (p = 0.06), our data showed that the T2 cluster had more daily spiritual experiences, felt closer to G-d (p = 0.01), and were more likely to understand the SenP as a guide (p ≤ 0.04).

Table 1.

Index demographic and descriptive table

 Index demographic and descriptive table
 Index demographic and descriptive table

We next examined the interrelatedness of overall SenP, APS, and transliminality (see Fig. 1). Our data show a significant positive association between transliminality and SenP frequency (p ≤ 0.001), SenP distress (p ≤ 0.001), SenP vividness (p ≤ 0.001), and SenP total score (p ≤ 0.001). Transliminality was also significantly associated with APS (PQ-16 total scores: p ≤ 0.001) and the level of distress related to APS (p ≤ 0.001). These findings demonstrate that individuals with higher transliminality were more likely to experience SenP with higher frequency, vividness, distress, and total scores. Additionally, higher SenP scores were significantly associated with higher APS (p ≤ 0.001) and a higher level of distress caused by APS (p ≤ 0.001).

Fig. 1.

Heatmap Correlogram of Transliminality (RTS-17), Sensed Presence Questionnaire (SenPQ), and Prodromal Questionnaire (PQ-16). SenPQ, Sense of Presence Questionnaire; PQ, the Prodromal Questionnaire.

Fig. 1.

Heatmap Correlogram of Transliminality (RTS-17), Sensed Presence Questionnaire (SenPQ), and Prodromal Questionnaire (PQ-16). SenPQ, Sense of Presence Questionnaire; PQ, the Prodromal Questionnaire.

Close modal

To examine the more nuanced interrelatedness of these findings, we examined the association between transliminality clusters, SenP, and APS scores (see Table 2). Our data showed that the high transliminality cluster (T3) had significantly higher SenP frequency (p ≤ 0.001), SenP distress (p ≤ 0.001), SenP vividness (p ≤ 0.001), and SenP total score (p ≤ 0.001) compared to the low transliminality cluster (T1) and moderate transliminality cluster (T2). Bonferroni post hoc tests showed a significant difference between clusters in all SenP domains with the exception of SenP vividness (T2 and T3, p = 0.06). Additionally, the T3 cluster showed significantly higher PQ-16 scores (p ≤ 0.001) and a higher degree of distress caused by APS (p ≤ 0.001). The T3 cluster met criteria for ultra-high risk to develop psychosis (M = 7.10). A post hoc Bonferroni test showed that APS (PQ-16) was not significantly different between T1 and T2 (p = 0.18); however, T1 and T3 (p ≤ 0.001) and T2 and T3 (p ≤ 0.001) were significantly different. Likewise, the post hoc Bonferroni test showed that the level of distress caused by experiences associated with APS was not significantly different between T1 and T2 (p = 1.00); however, T1 and T3 (p ≤ 0.001) and T2 and T3 (p = 0.002) were significantly different.

Table 2.

Primary measures by degree of transliminality

 Primary measures by degree of transliminality
 Primary measures by degree of transliminality

Together with descriptive findings, we show distinct characteristics between the clusters (see Fig. 2). Individuals in the T1 cluster (low transliminality) were least likely to endorse SenP experiences, transliminality experiences or beliefs, and least likely to experience APS. The T2 cluster (moderate transliminality) consisted of individuals with experiences of SenP, low APS, and moderate transliminality experiences or beliefs. The T2 cluster had more daily spiritual experiences and showed a higher overall feeling of closeness to G-d compared to T1 and T3. The T3 cluster (high transliminality) consisted of individuals who showed significantly higher APS scores and met criteria for ultra-high risk to develop psychosis. Additionally, T3 individuals were more likely to live alone, experience SenP at a younger age, and demonstrate an increased prevalence of out-of-body experiences compared to clusters T1 and T2.

Fig. 2.

Transliminality cluster distinction. T1, low transliminality cluster; T2, moderate transliminality cluster; T3, high transliminality cluster.

Fig. 2.

Transliminality cluster distinction. T1, low transliminality cluster; T2, moderate transliminality cluster; T3, high transliminality cluster.

Close modal

Psychosis and psychotic-like experiences as dimensional phenomena exist along a nonclinical and clinical population-based continuum [84‒87]. Similarly, we hypothesized that alterations in everydayness and commonsense as distinct dimensional phenomena also occur in nonpsychotic sensory and perceptual anomalous experiences, to a varying degree. This hypothesis received some support from the high frequency of SenP in the T2 cluster, even though this cluster did not show more APS than the T1 cluster who did not experience SenP. Anomalous experiences, such as SenP, can be experienced in the absence of APS (T2) and in the presence of APS (T3). The T2 cluster consisted of individuals with experiences of SenP who endorsed increased daily spiritual experiences, in the absence of significant APS, who had an overall feeling of closeness to G-d, and the meaning given to the SenP was that of a guide. This finding could be interpreted as belief generating expectancies of a spiritual presence; thus, the salience would not be experienced as aberrant, and meaning did not need to be given; it was already present, nor was the experience distressing. There was no significant difference between cluster T1 and T2 in the degree of APS or the level of distress. In fact, it is hard to know the direction of these causal relations: it could be that SenP led to religious beliefs, and/or it could be that religious belief incited individuals to look for, anticipate, or welcome the presence, whereas, in the T3 cluster, SenP is associated with distress, had higher APS and level of distress associated with the APS suggesting the experience of something aberrant and destabilization. To restabilize, meaning is given to the aberrant sensory perception that is weighted with internal reference embedded in personal history and culture as unconscious material breaks through the threshold of consciousness.

Gruhle’s analysis of the distinction between psychotic experiences and the experiences of a “medium” is marked by the expectancy and possibly anticipated nature of the experience [88, 89]. The medium “in a state of possession imparts the thoughts of the spirit possessing her…is conscious of her role as a medium, and even if the possession is against her will…and may be surprised by one’s own thoughts and even learn from them… because they occur within a more or less expected context [88].” In entering the phenomenological experience of possession, the medium may experience an alteration in everydayness and commonsense; however, the individual is not distressed as it is the “meaning given” within the societal or community acceptance of the experience. Our findings support Gruhle’s distinction, and it is interesting to note that in the case of the T2 cluster, it might happen that some participants were looking for SenP, which would be congruent with their beliefs. In that case, SenP would not come as a surprise but would be welcomed. If expected, the SenP may not lack agency, and should not produce aberrant salience, nor post hoc interpretation. It would be integrated in the individual’s beliefs. Inasmuch as this should not produce any distress, as also observed in the T2 cluster, it can be considered nonpathological. Hence, we hypothesize that the T2/T3 distinction rests in the triangulation of anomalous sensory and perceptual experiences, APS, and transliminality in addition to the “meaning given” a priori or a posteriori to the experience within the societal or community acceptance of the SenP experience. However, there remains much debate in the literature as to the pathological nature of SenP as part of the bereavement process and in religious or mystical experiences that could be extended to SenP in general [41, 90].

Previous research that has focused on the intersection of spiritual experiences and absorption situated within a cultural context showed that absorption, an element of transliminality, was highly correlated with religious experiences in which the individual interprets the increased sensory and perceptual experience as a felt or sensed spiritual presence [7, 91‒94]. This is consistent with our data that identified a distinct cluster (T2), with a high degree of spirituality, feelings of closeness to G-d, in which the meaning of the SenP was that of a guide, experienced SenP, with a moderate degree of transliminality, in the absence of significant APS. Our results also expand on our previous research that showed a higher degree of absorption in individuals with psychosis when compared to individuals without psychosis [54, 71]. Increased transliminality/absorption and SenP have been associated with both experiences of increased spirituality and closeness to G-d and have been associated with alteration in the basic sense of self (self-disturbances). Inasmuch as increased APS is considered downstream of self-disturbances, our results linking transliminality and APS are consistent with the observed associations. The findings of this study demonstrate a strong association between transliminality, APS, and multiple dimensions of SenP (frequency, distress, vividness, and total scores). Interestingly, the vividness of the SenP was not significantly different between T2 and T3. However, the SenP frequency and level of distress were distinctly differentiated between the clusters. There was no significant difference between T1 and T2 in the prevalence of APS nor in the level of distress associated with APS, whereas SenP frequency, distress total scores, transliminality, and APS were all significantly higher in the T3 cluster. Thus, we argue that SenP is uniquely experienced between clusters which hinge on the degree of transliminality or absorption [54, 71, 94]. Thus, our findings demonstrate a strong association and entanglement of these experiences which suggest transliminality/absorption and increased APS may serve as a potentially provocative underlying structure in the phenomenology of SenP.

The hypotheses of phenomenologists may be especially pertinent for the T3 cluster. Jaspers (1913) described SenP (Leibhaftige Bewussstheit) in a clinical population as “patients who have a certain feeling (in the mental sense) or awareness that someone is close by, behind them or above them, someone that they can in no way actually perceive with the external senses, yet whose actual/concrete presence is directly and clearly experienced [30, 95].” It has been argued that SenP can best be understood as a sensory or perceptual basic-symptom phenomenon that is fundamentally entangled in foundational disruptions of the basic sense of self (self-disturbances) [96, 97]. Basic symptoms are conceptualized as nonpsychotic sub-clinical disturbances associated with affect, cognition, perception, and motor/physical alterations associated with basic self-disturbances [97‒99]. The multiplicity of self as a construct consists of both a narrative or reflective self (personality traits, values, history) and the pre-reflective self (unconscious) [100‒102]. Basic self-disturbances are rooted in the pre-reflective self, associated with connectivity or coherence of ownership and agency [103]. Basic self-disturbance is associated with ultra-high-risk prodrome in individuals who transition to psychosis and is predictive of clinical course and functional outcome [104‒106]. The origin of the term Ichstörungen (self-disturbances) has been attributed to Jaspers (1913) [30]. Although Gruhle, and other members of the Early Heidelberg School of Psychiatry, especially Mayer-Gross and Beringer, described and developed the “self-disturbances” concept in schizophrenia [88, 107‒109], it was Gruhle who first coined the term self-disturbances in application to schizophrenia. Sass, Parnas, and others further developed the construct and hypothesize that self-disturbance (Ipsiety) involves both hyperreflectivity and diminished self-affection [110‒112]. It has been hypothesized that full-fledged hallucinations and delusions are downstream from core alteration of basic self-experience, while increased salience is often reported in conjunction with increased self-disturbance [54, 57].

Limitations

There are several limitations of this study that include the modest number of individuals across the transliminality clusters. Another limitation to the generalizability of these results is that the data are based entirely on self-report and given the cultural influences our results may not generalize to other regions and populations. Importantly, given the established links between SenP, spiritual experience/openness, transliminality/absorption, and the links between SenP, transliminality/absorption, and psychosis, research explicitly designed to examine the nuanced points of convergence and divergence of these intersects as situated within the cultural acceptance of these experiences at both the individual and societal level is required. However, even within the context of said limitations, this study provides results that contribute to understanding the role of transliminality/absorption and APS in relation to SenP.

SenP exists along a continuum spanning nonclinical, prodrome, and clinical populations. SenP is a highly heterogeneous, complex, and rich phenomenon that can take a variety of forms that manifest through multiple modalities varying in degree of frequency, distress, and vividness. The meaning given to the experience also varies widely. The results of this study foreground this complexity. The provocative underlying role of transliminality/absorption and APS in SenP requires a more comprehensive examination of these phenomena that demand nuanced microphenomenological mixed-method research designs. The subjective experience of SenP as described by participants included general changes in the sense of being “Often there are changes in room temperature. Sometimes there is a perceived busyness or energetic agitation felt when a presence enters my space” to more specifically defined alterations“Usually in two forms- 1) the presence/spirit of someone I know who is close to me, a recently passed family member, or someone from my past… 2) non-identifiable energies usually associated with a specific mood, location, or gathering. Happens more often when I'm either alone or out in nature. I sense something near…” In addition, the quasi-agentive nature and range of personification of SenP underscore the importance of greater attention to the role of agency in this experience, as described by a study participant, “It knows that I’m aware of it.” Lastly, SenP as a microcosm of madness, when bracketed, may provide a window into the experiences of hallucinations and delusions and the meaning given as influenced by the individual’s unconscious, history, culture, and the external societal acceptance of the experience. Debate remains ongoing as to when and under what circumstances SenP is considered pathological and remains an issue to be grappled with. Sensing the presence of G-d in a religious experience, sensing the deceased during bereavement, or sensing energy as in a mystical experience is accepted and at times something one strives for and welcomes within the cultural context. Yet when situated under the clinical gaze, SenP risks being framed as hallucinations and its meaning or interpretation assigned as delusions in the context of madness.

The authors would like to thank all participants for their time and contribution to this research study.

This study protocol was reviewed and approved by the Vanderbilt University Institutional Review Board and received an exempt determination, approval number IRB #212181. Informed consent was obtained from participants to participate in the study. The anonymous study has been granted an exemption from requiring formal written informed consent. The research was conducted in compliance with the guidelines for human studies and ethically in accordance with the World Medical Association Declaration of Helsinki.

The authors have no conflicts of interest to declare.

Dr Sohee Park receives funding under the Gertrude Conaway Vanderbilt Professor endowment. The funding source had no role in the study design; collection, analysis, and interpretation of data; and writing of the report.

Cherise Rosen: conceptualization, investigation, methodology, data curation, formal analysis, and writing – original draft and review and editing. Sohee Park: funding acquisition, conceptualization, investigation, methodology, data curation, resources, writing – review and editing, and project administration. Tatiana Baxter: conceptualization, investigation, methodology, data curation, and writing – review and editing. Michele Tufano and Anne Giersch: writing – review and editing. All authors contributed to and have approved the final manuscript.

All data generated or analyzed during this study are presented in this article. Further inquiries can be directed to the corresponding author.

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