Talk:Mirrored-self misidentification

Would

Would a mention of domestic dogs' behaviour around a mirror be appropriate? My dog, and many others I've seen, will bark and growl at and even try to bite the dog in the mirror.

-b —Preceding unsigned comment added by 64.81.139.240 (talk • contribs) 15:03, 9 April 2006

I don't think so, this article is about a psychological disorder found only in humans, as for most animals not recognising one's mirror image is the norm. --Florian Blaschke (talk) 21:12, 24 April 2014 (UTC)

Student edits begin

Greta Munger (talk) 15:23, 17 April 2014 (UTC)

Proposed Changes

Currently, the mirrored-self misidentification Wikipedia article does not accurately represent the current knowledge about the delusion. While the current Wikipedia article includes good and accurate information, much needs to be expanded upon and restructured. More specifically, I wish to keep the basis of the introduction, but plan to expand and reorganize it. The ‘theories’ section that is currently included in the article is a good skeleton for the section, but again it needs to be expanded. I also wish to keep the two studies that are included in the current article. However, the studies should be summarized more concisely and reorganized under different subtitles that highlight their significance. I therefore propose to significantly expand this article by adding the following subsections and information, currently proposed in outline form:

Definition:

- delusional belief that one’s reflection in the mirror is another person ---- him or herself when younger, a stranger, a relative (different on case-by-case basis)

- intact ability to recognize others in a mirror

- included among the delusional misidentification syndromes (DMS) --- conditions in which the patient misidentifies persons, places, objects, events

- considered a monothematic delusion --- a delusion related to one single topic, or a group of delusions related to a single theme. As opposed to a polythematic delusion

- 8 examples of monothematic delusions: Capgras delusion, Fregoli delusion, Cotard delusion, mirrored-self misidentification, reduplicative paramnesia, unilateral neglect, alien control, thought insertion

Prevalence:

- occurs most frequently in patients with dementia --- especially Alzheimer’s o 2-10% of patients with Alzheimer’s misidentify their reflection in the mirror - reported in patients with schizophrenia, right frontal ischemic stroke

- exact prevalence is unknown because it can be overlooked in a typical neurological / psychoneurological workup. Dependent on the family to recognize the delusion

- DMS in general can occur in a lot of different diseases that affect different systems of the brain

- A few cases in patients with advanced Parkinson’s disease

Two-factor theory of delusional belief:

- proposed by Coltheart et al

- to understand monothematic delusions, there are two factors involved:

o First factor answers the question – what prompted the delusional idea? Deals with the delusion content.

o Second factor answers the question – why is this delusion an accepted belief rather than rejected due to implausibility or bizarreness? Deals with the persistence of the delusion

- Factor 1: either mirror agnosia (inability to use mirror knowledge when interacting with mirrors) or impaired face processing prompt the delusion

o But not all people with mirror agnosia or all people with impaired facial processing develop the delusions --- there needs to be a second factor

- Factor 2: always some type of impairment of the right hemisphere makes the delusion an accepted belief

- Patients who have both factor 1 and 2 will develop the delusion. If you have one or the other, you won’t develop the delusion

Research leading to two-factor theory:

- Two case studies

o Patient TH • Early stages of dementia • Had mirror agnosia: inability to understand how mirrors work. Mirrors are seen as windows or holes in the wall. • TH looks into mirror – object held up behind his shoulder is reflected in the mirror. He tries to reach into the mirror rather than behind him. • Belief that the mirror represents a space different from that of the viewer prompted TH’s idea that his reflection in the mirror is someone else other than him. • Answers the first question --- factor 1 • But not all other patients with mirror agnosia have mirrored-self misidentification • Neuropsychological testing showed impaired right hemisphere • Normal intelligence, verbal memory, vocabulary and semantic ability. Basic visuoperceptual skills were there, but he displayed visuoconstructional problems and poor visual memory ---- indicative of profound right hemisphere dysfunction. • Also unable to accurately weigh beliefs vs evidence due to cranial damage • This explains factor 2!

o Patient FE • Early stages of dementia • Understood mirrors --- no mirror agnosia. • BUT acquired impairment of face processing. When he looked into the mirror, he had abnormal perception of the reflected face. He couldn’t match the reflection to the memory of what his face looked like. • This prompted factor 1 --- the person in the mirror isn’t him. • Other patients with impaired face processing don’t have mirrored-self misidentification. Patients with prosopagnosia. • Neuropsychological testing showed right hemisphere impairment ---- same thing as TH (see above).

Neurological basis:

- right hemisphere dysfunction

- patients with misidentification syndromes have larger left frontal lobes, larger right anterior horns than the typical patient --- indicates right frontal atrophy

- over activity of preserved left hemisphere areas

- impairment of areas in the brain that enables us to recognize faces

o especially areas that help us recognize the self. In very specific extreme cases, if the damage goes to other areas of the brain, the patient may not be able to recognize other faces. But when this happens, the patient relies on things like body or voice recognition (non-face cues) to recognize the other person. When looking in a mirror, the patient has to rely solely on face-cues --- which they can’t do due to cranial damage

- impairment of areas that enable us to reject delusions based on implausibility / bizarreness

Self-recognition in ‘normal’ patients:

- viewing one’s own face leads to changes in inferior frontal gyrus, inferior occipital gyrus, and the inferior parietal lobe in the right hemisphere

- right hemisphere is involved in processing self-related stimuli

- right fronto-parietal area is activated when viewing one’s own face rather than when viewing a familiar face – highlights the special role of right hemisphere in self-related cognition

o damage to this area causes patients to misidentify their own face but they can still recognize others’ faces • delusions such as mirrored-self misidentification can occur when damage to this area of the brain occurs

Methods of studying mirrored-self misidentification:

- Clinical cases

- Hypnosis

o Good to study delusions because it can cause cognitive disruptions without neurological damage, allowing researchers to recreate clinical delusions in healthy participants o Can generate false beliefs (create factor 1) and disrupt normal cognitive evaluation (create factor 2) with no lasting consequences o There are different types of hypnosis, with “cognitive-delusory” being the most difficult type of hypnosis to enter. To recreate mirrored-self misidentification, only those who are very highly susceptible to hypnosis can be participants o Hypnotic delusions are very similar to clinical delusions: similarities include phenomenological features of delusions, delusional resistance to challenge, autobiographical memory during delusions o Both clinical and hypnotic patients report their beliefs with conviction, hold onto their beliefs when confronted with evidence that contradicts them, and provide confabulatory explanations to account for their delusional beliefs o Therefore a good model to study delusions!! --- particularly mirrored-self misidentification

Other delusional comorbidities:

- other DMS delusions can be common

- phantom border delusional misidentification symptom (PBS) – the belief that another person is living in one’s home. o Comes from patients misidentifying their mirror image

Treatment:

- no specific treatment for mirrored-self misidentification

- general treatment for delusions: cognitive-behavioral therapy

- Individual therapy may be best suited to treat the individual’s unique delusions --- must be done with persistence

- Antipsychotics can be used to treat delusions but have some limited success.

References

Coltheart, M. (2011). The mirrored-self misidentification delusion. Neuropsychiatry, 1(6), 521.

Villarejo, A., Martin, V. P., Moreno-Ramos, T., Camacho-Salas, A., Porta-Etessam, J., & Bermejo-Pareja, F. (2011). Mirrored-self misidentification in a patient without dementia: evidence for right hemispheric and bifrontal damage. Neurocase, 17(3), 276-284. doi: 10.1080/13554794.2010.498427

Uddin, L. Q., Kaplan, J. T., Molnar-Szakacs, I., Zaidel, E., & Iacoboni, M. (2004). Self-face recognition activates a frontoparietal “mirror” network in the right hemisphere: an event-related fMRI study. NeuroImage

Bredart, S. & Young, A. (2004). Self-recognition in everyday life. Cognitive Neuropsychiatry, 9(3), 183-197. doi: 10.1080/13546800344000075

Keenan, J. P., Wheeler, M., Platek, S. M., Lardi, G., Lassonde, M. (2003). Self-face processing in a callostomy patient. European Journal of Neuroscience, 18, 2391-2395. doi: 10.1046/j.1460-9568.2003.02958.x

Kaplan, J. T., Aziz-Zadeh, L., Uddin, L. Q, & Iacoboni, M. (2008). The self across the senses: an fMRI study of self-face and self-voice recognition. Social Cognitive and Affective Neuroscience, 3, 218-223. doi: 10.1093/scan/nsn014

Platek, S. M., & Gallup, G. G. (2002). A self frozen in time and space: Catatonia as a kinesthetic analog to mirrored self-misidentification. Behavioral and Brain Sciences, 25(5), 589-590.

Connors, M. H., Barnier, A. J., Langdon, R., Cox, R. E., Polito, V., & Coltheart, M. (2013). Delusions in the hypnosis laboratory: modeling different pathways to mirrored-self misidentification. Psychology of Consciousness: Theory, Research, and Practice. doi: 10.1037/css0000001

Sui, J., & Han, S. (2007). Self-construal priming modulates neural substrates of self-awareness. Psychological Sciences, 18(10), 861-866.

Postal, K. S. (2005). The mirror sign delusional misidentification symptom. In T. E. Feinberg & J. P. Keenan (Eds.), Lost self: Pathologies of the brain and identity (131-147). Cary, NC: Oxford University Press.

Davies, M., Coltheart, M., Langdon, R., & Breen, N. (2001). Monothematic delusions: Towards a two-factor theory. Philosophy, Psychiatry, & Psychology, 8(2/3), 133-158. doi: 10.1353/ppp.2001.0007

Moro, A., Munhoz, R. P., Moschovich, M., Arruda, W. O., & Teive, H. A. G. (2013). Delusional misidentification syndrome and other unusual delusions in advanced Parkinson’s disease. Parkinsonism and Related Disorders, 19, 751-754.

Van den Stock, J., de Gelder, B., de Winter, F., van Laere, K., & Vandenbulcke, M. (2012). A strange face in the mirror. Face-selective misidentification in a patient with right lateralized occipito-temporal hypo-metabolism. Cortex, 48, 1088-1090. doi: 10.1016/j.cortex.2012.03.003

Breen, N., Caine, D., & Coltheart, M. (2001). Mirrored-self misidentification: Two cases of focal onset dementia. Neurocase, 7, 239-254.

Serruya, G. & Grant, P. (2009). Cognitive-behavioral therapy of delusions: Mental imagery within a goal-directed framework. Journal of Clinical Psychology, 65(8), 791-802. doi: 10.1002/jclp.20616

Cox, R. E., & Barnier, A. J. (2010). Hypnotic illusions and clinical delusions: Hypnosis as a research method. Cognitive Neuropsychiatry, 15(1/2/3), 202-232. doi: 10.1080/13546800903319884

Bortolotti, L., Cox, R., & Barnier, A. (2012). Can we recreate delusions in the laboratory? Philosophical Psychology, 25(1), 109-131.

Langdon, R. (2011). The cognitive neuropsychiatry of delusional belief. Cognitive Neuroscience, 2, 449-460. doi: 10.1002/wcs.121

Feinberg, T. E., & Roane, D. M. (2005). Delusional misidentification. Psychiatric Clinic of North America, 28, 665-683. doi: 10.1016/j.psc.2005.05.002

Connors, M. H., Barnier, A. J., Langdon, R., Cox, R. E., Polito, V., & Coltheart, M. (2013). A laboratory analogue of mirrored-self misidentification delusion: The role of hypnosis, suggestion, and demand characteristics. Consciousness and Cognition, 22, 1510-1522.

Hirstein, W. (2005). Mind reading and misidentification. Brain Fiction: Self-deception and the riddle of confabulation (101-134). Cambridge, MA: MIT Press.

Franks. D. D. (2010). The self in neuroscience and social psychology. Neurosociology: The nexus between neuroscience and social psychology (129-156). Richmond, VA: Springer Science + Business Media.

Margaret Cookson (talk) 19:48, 17 April 2014 (UTC)

References and sections look very nice. Plan to include different kinds of research support very nice, and helpful to have those labelled as you do.

• Organization: remember that people hop around in reading Wikipedia articles, so make each little section as independent as you can
• Methods: nice that you have that built in, might be helpful to keep in mind these descriptions: 3 research methods (experiments vs correlation vs descriptive); 2 data-collection (self-report vs observation); 2 research settings (lab vs field)
• Figures and tables: be thoughtful. Wikicommons has lots of pictures that might be useful. You cannot copy directly from journal articles (copyright violation), but you can recreate a figure and then donate it yourself. Only include a brain picture if there is one specifically relevant. Greta Munger (talk) 14:19, 22 April 2014 (UTC)

PEER REVIEW

Be sure to define “theme” in the discussion of “monothematic” and “polythematic,” not quite clear what that means

When you mention that it’s up to the family to “recognize the delusion,” are there any specific cues you could provide as examples to look for?

Perhaps you already have these details, but it might be useful to provide examples of what systems are associated with DMS and what research (not evens sure if this has been found or not, maybe not!) says could be the common thread. Perhaps the Neurological basis section will cover this. If so maybe just linking to that section would work? I know Dr. Munger has reminded many of us that people skip around in Wikipedia articles, so maybe creating a direct link would help.

I’m not sure how to best direct this reorganization, but it might be useful to place the info from “Self-recognition in ‘normal’ patients” a little higher in the article so that readers get a comparison between “normal” and those suffering from DMS right off the bat. Perhaps putting a sentence or two about this in the intro would help and then you can keep the rest as is because of the tendency of readers to jump around anyway.

The “Methods of studying…” section will probably want to be broken up. It seems like you have a lot of good stuff on that so definitely defining subsections would help. Probably same with treatment.

Caqueen (talk)caqueen — Preceding undated comment added 20:50, 24 April 2014 (UTC)

Mirror agnosia

Should Mirror agnosia redirect here? I'm not sure how the two terms mirror agnosia and mirrored-self misidentification (whew, that's quite a mouthful) relate to each other. Is mirror agnosia a subtype of mirrored-self misidentification? --Florian Blaschke (talk) 21:09, 24 April 2014 (UTC)

Use of the term "cranial" throughout the item "Mirrored-self misidentification"

  I'm not a physician or anatomist, but I think that, in the contexts used, the word "cranial" is incorrect- the original author means "cerebral",
 e.g. "cerebral dysfunction" should be substituted for "cranial dysfunction". The syndrome(s) discussed are not- in contemporary scientific English usage- "cranial" in origin.

JDJ, 19/10/16 217.35.225.167 (talk) 20:51, 19 October 2016 (UTC)