Metacognitive delusions: what are they, causes and main symptoms?

They can appear in disorders such as schizophrenia.

We live in times where the concept of privacy is beginning to lose its meaning: people make use of social networks to report almost everything that happens in our daily lives, turning the everyday into a public act..

However, we harbor a bastion that is impregnable to the gaze of others: intimate thoughts. At least until today, what we think about remains private, unless we deliberately reveal it.

Metacognitive delusions, however, act (for the sufferer) as a battering ram that knocks down such an impenetrable wall, exposing mental contents or making it easier for others to access them and modify them as they wish.

These are disturbances in the content of thought, which often occur in the context of psychotic disorders such as schizophrenia. Their presence coexists, in addition, with a deep sensation of anguish.

• Recommended article: "The 12 most curious and shocking types of delusions".

Metacognitive delusions

The metacognitive deliriums constitute an alteration in the processes from which an individual assumes consciousness of the confluences which constitute his mental activity (emotion, thought, etc.). (emotion, thought, etc.), integrating them into a congruent unit that is recognized as its own (and distinct in turn from that possessed by others). Therefore, it is essential to identify ourselves as subjects with cognitive autonomy, and to be able to think about what we think and to feel about what we feel.

In this regard, there are a number of delusional phenomena that can be understood as disturbances of metacognition, as they alter the ability to reason correctly about the nature of the mental product or about the attribution of its origin. For example, an individual may perceive (and express verbally) that what he is thinking is not his own elaboration, or that certain contents have been subtracted from his head through the participation of an external entity.

All these phenomena imply the dissolution of the self as the agent that monitors and coordinates mental life, which becomes conditioned by the influence of "persons" or "organizations" that are located somewhere outside and over which one lacks control or even knowledge. This is why they have often been categorized as delusions of passivity, since the individual would perceive himself (with distress) as the receptacle of an alien will.

In the following we will delve into the most relevant metacognitive delusions: control, theft, reading and thought insertion.. It is important to take into consideration that on many occasions two or more of them may occur at the same time, because in their synthesis there is a logic that may be part of the delusions of persecution that occur in the context of paranoid schizophrenia.

1. Thought control

People understand our mental activity as a private exercise, in which we tend to deploy a will-driven discourse. However, a high percentage of people with schizophrenia (approximately 20%) state that this is not guided by their own designs, but is manipulated from some external source (spirit, machine, organization, etc.) through a specific and invasive mechanism (such as telepathy or experimental technologies).

It is for this reason that they develop a belligerent attitude towards some of their mental contents, through which a deliberate attempt is perceived to take away their ability to proceed from their free will.The delirium is perceived as a deliberate attempt to take away their capacity to proceed from their free will. In this sense, delirium assumes an intimate dimension that denotes a deep anguish from which it is difficult to escape. Attempts to escape from it only increase the emotion, which is often accompanied by a fierce suspicion.

Delusions of control may be the result of a misinterpretation of automatic and negative mental contents, which are a common phenomenon in the general population, but whose intrusiveness in this case would be assessed as subject to the domain of a third party. The avoidance of these ideas tends to increase their persistence and availability, which would intensify the feeling of threat.

The strategies to avoid this manipulation can be very varied: from the assumption of an attitude of suspicion before any interaction with people in whom one does not place full trust, to the modification of the space in which one lives with the inclusion of elements aimed at "attenuating" the influence on the mind (isolations in the walls, for example). In any case, it implies a problem that deeply impairs the development of daily life and social relations.

2. Thought theft

Thought theft consists of the belief that a concrete element of the mental activity has been extracted by some external agent, with a perverse or perverse purpose.for a perverse or harmful purpose. This delirium is usually the result of irrationally interpreting the difficulty in accessing declarative memories (episodic, for example), which are considered relevant or which may contain sensitive information.

Subjects presenting this delirium often report that they are unable to speak as they would wish because the thoughts necessary for their expression have been subtracted by an external force (more or less known), which has left their mind "blank" or without "useful" ideas. Thus, this phenomenon can also arise as a distorted interpretation of the poverty of thought and/or emotion (alogia), a negative symptom characteristic of schizophrenia.

Thought theft is experienced in a distressing way, since it involves the decomposition of one's life history and the gripping sensation that someone is hoarding one's personal experiences. The privacy of one's own mind is involuntarily exposed, precipitating a cervical fear of psychological inquiries (interviews, questionnaires, self-records, etc.), which may be perceived as an additional attempt at subtraction.

3. Diffusion of thought

Thought reading is a phenomenon similar to the previous one, which is included (along with the others) under the general heading of alienated cognition. In this case the subject perceives that the mental content is projected outward in a manner similar to that of the spoken voice, instead of remaining in the silence characteristic of all thoughts. Thus, he may have the feeling that when he thinks, other people can immediately know what he is saying to himself (as it would sound "out loud"). (as it would sound "out loud").

The main difference with respect to thought theft is that in the latter case there is no deliberate subtraction, but the thought would have lost its essence of privacy and would be displayed before others against one's own will. Sometimes the phenomenon is bidirectional, which would mean that the patient adds that it is also easy for him to access the minds of others.

As can be seen, a laxity of the virtual barriers that isolate one's private worlds is manifested. The explanations given for the delirium are usually of an incredible nature (encounter with extraterrestrial beings, existence of a specific machine being tested on the person, etc.), so it should never be confused with the cognitive bias of thought reading (non-pathological belief that one knows the will of the other without the need to inquire into it).

4. Thought insertion

Thought insertion is a delusional idea closely linked to thought theft.. In this case, the person values that certain ideas are not his own, that they have not been elaborated by his will or that they describe facts that he never lived in his own skin. Thus, one appreciates that a percentage of what one believes or remembers is not one's own, but has been imposed by someone from the outside.

When combined with the subtraction of thought, the subject comes to feel passive about what is happening inside him. Thus, he would set himself up as an external observer of the flow of his cognitive and emotional life, completely losing control over what may happen in it. The insertion of thought is often accompanied by ideas regarding its control, which were described in the first of the epigraphs.

Treatment

Delusions such as those described usually break out in the context of acute episodes of a psychotic disorder, and thus tend to fluctuate in the same individual, within a spectrum of severity. Classical therapeutic interventions involve the use of antipsychotic drugs, which chemically exert an antagonistic effect on dopamine receptors in the four brain pathways available to the neurotransmitter (mesocortical, mesolimbic, nigrostriatal and tuberoinfundibular).

Atypical antipsychotics have been successful in reducing the severe side effects associated with the use of this drug, although they have not been totally eliminated. These compounds require the direct supervision of the physician, both in their dosage and in their eventual modification. Despite the unspecificity of their action, they are useful in reducing positive symptoms (such as hallucinations and delusions), as they act on the mesolimbic pathway on which these depend. However, they are less effective for negative symptoms (apathy, abulia, alogia and anhedonia), which are associated with the mesocortical pathway.

There are also psychological approaches that in recent years are increasing their presence for this type of problems, especially cognitive-behavioral therapy. In this case, delirium is considered as an idea that has similarities with non-delusional thinking, and whose discrepancies lie in a question associated with information processing. The benefits and scope of this strategy will require further research in the future.

Bibliographical references:

• Tenorio, F. (2016). Psychosis and Schizophrenia: Effects of Changes in Psychiatric Classifications on Clinical and Theoretical Approaches to Mental Illness. História, Ciências e Saúde-Manguinhos, 23(4), 941-963.
• Villagrán, J.M. (2003). Consciousness Disorders in Schizophrenia: a Forgotten Land for Psychopathology. International Journal of Psychology and Psychological Therapy, 3(2), 209-234.