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The Reality Distortion and Thought Disorganisation Dimensions

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Dimensional Psychopathology

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Abstract

The Reality Distortion dimension is characterised by erroneous perception or cognition of reality and includes disorders of thought content as well as illusions and hallucinations. Because psychotic experiences can be observed in patients with nonpsychotic mental disorders and in healthy subjects, the classical dichotomous definition of psychosis has been questioned in favour of a continuum view. Structural and functional brain abnormalities and hyperactivity of dopaminergic systems as correlates of reality distortion are mainly inferred from studies of schizophrenia. SVARAD scores across categorical diagnoses have detected low but clinically significant levels of reality distortion in patients with depressive disorders, obsessive-compulsive disorder, eating disorders, and borderline personality disorder. Antipsychotics are effective in reducing positive psychotic symptoms, and they can have an important role in the treatment of reality distortion in nonpsychotic mental disorders. Specific psychological interventions (mainly cognitive-behavioural therapy) addressing reality distortion symptoms have shown significant improvement in patients with psychotic disorders. The Thought Disorganisation dimension reflects an abnormal organisation of thought, which can lead to both disorganised speech and behaviour. In addition to schizophrenia, the disorganisation dimension can be detected in other mental disorders. The neurobiology underlying the Thought Disorganisation dimension is not completely understood. Structural neuroimaging in patients with thought disorders has found changes in different areas. The glutamate metabolism pathway has been described as a potential molecular mechanism influencing cognition and disorganisation in schizophrenia. Using the SVARAD with psychiatric inpatients, Thought Disorganisation dimension symptoms were detected in patients with severe nonpsychotic disorders, as well as mood disorders and borderline personality disorders. Treatment for Thought Disorganisation dimension symptoms presents some controversies, but some antipsychotic agents appear more effective than others, and psychosocial intervention might reduce the impact of disorganisation on functioning.

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Authors and Affiliations

  1. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Lorenzo Tarsitani & Annalisa Maraone

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  1. Lorenzo Tarsitani
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  2. Annalisa Maraone
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Correspondence to Lorenzo Tarsitani .

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  1. Department of Human Neurosciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy

    Massimo Biondi

  2. Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Massimo Pasquini

  3. Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy

    Angelo Picardi

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Tarsitani, L., Maraone, A. (2018). The Reality Distortion and Thought Disorganisation Dimensions. In: Biondi, M., Pasquini, M., Picardi, A. (eds) Dimensional Psychopathology. Springer, Cham. https://doi.org/10.1007/978-3-319-78202-7_4

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