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Clinical observations suggest early self-consciousness disturbances in schizophrenia. A double mirror combining the images of two individuals sitting on each side of the mirror was used to study self–other differentiation in 12 individuals with early onset schizophrenia (EOS) and 15 individuals with adult onset schizophrenia (AOS) compared to 27 typically developing controls (TDC) matched on age and sex. The effects of intermodal sensory perception (visual–tactile and visual–kinesthetic) on self–other recognition were also studied. The results showed that EOS and AOS individuals, independently of age and schizophrenia severity, were centered on their own image compared to TDC, with both significant earlier self-recognition and delayed other-recognition during the visual recognition task. In addition, there was no significant effect of intermodal sensory stimulation on self–other recognition in EOS and AOS patients, whereas self-centered functioning was significantly increased by visual–tactile stimulation and decreased by visual–kinesthetic stimulation in TDC. The findings suggest that self–other recognition impairments might be a possible endophenotypic trait of schizophrenia.

Prior observations and studies suggest self-consciousness disorders in schizophrenia and Autism Spectrum Disorder (ASD), two neurodevelopmental disorders sharing social communication impairments. First, the relationships between schizophrenia and autism are explored regarding social communication impairments. Then, self-consciousness disorders in schizophrenia and autism are described and discussed in relation with impairments of body self leading to impairments of self-other differentiation, a deficit of theory of mind and empathy, and their consequences on social communication. Also, neurological dysfunction involved possibly in self-consciousness disorders in schizophrenia and autism is presented. In conclusion, a new model is proposed integrating results of studies presented here and stating the existence of bodily self-consciousness disorders in schizophrenia and autism associated with altered/absent intermodal sensory integration (especially visual-kinesthetic-tactile integration). This would result in problems of self-other differentiation, leading in turn to a deficit of theory of mind and empathy as well as social communication impairments. This model opens new perspectives to understand better self-consciousness disorders and social communication impairments in schizophrenia and ASD and to develop therapeutic strategies.

Self-experience impairments have been described since many years as part of core features of schizophrenia, but are currently neglected in research and clinical practice. First, a literature review on self-consciousness is developed in this article with regard to definitions (including the concepts of self and self-consciousness) and different approaches (especially cognitive, developmental and neurobiological approaches). Self-consciousness can be divided into three levels: minimal-self with implicit pre-reflexive consciousness, reflexive-self with explicit reflexive consciousness (consciousness of a permanent self as an invariant over time through multiple experiences and actions), and social-self (style, habits, and historical narrativity) with explicit self-consciousness. These levels appear progressively in the child from bodily perception (pre-reflexive consciousness) to identification of the self in the mirror at approximatively two-years old (reflexive consciousness) and appearance of mental representations later (self-consciousness). Second, self-consciousness impairments observed in schizophrenia are described in this article and discussed in light of the literature presented. Converging evidence suggests that exploring self-disorders in schizophrenia could help clinicians to understand daily-life patients difficulties and might be of interest for developing a therapeutic alliance. Finally, this critical literature review opens new perspectives to understand better disorders of the self and social interaction impairments in schizophrenia, and to propose a therapeutic use of the mirror based on cognitive remediation helping individuals with schizophrenia to improve self-other differentiation.