Crisis of objectivity: using a personalized network model to understand maladaptive sensemaking in a patient with psychotic, affective, and obsessive-compulsive symptoms

Introduction: Psychiatric comorbidity challenges both research and treatment, motivating shifts from categorical to dimensional approaches. From a phenomenological psychopathology perspective, a richer account of lived experience is also needed. Personalized network models (PNMs) offer a phenomenology-informed way to depict a person’s lifeworld as nodes and relations. We present a detailed, multi-method case study of a patient with multiple comorbidities and adverse childhood experiences. Methods: Over two years, we collected phenomenological interviews, neuropsychological assessments, language analysis, and EASE/EAWE semi-structured interviews, and analytically constructed a personalized network model. Results: We identified an experiential category—the “crisis of objectivity” (persistent mistrust of subjective information)—as the core psychopathological theme. Developmentally, this traced to adverse childhood experiences and a frank psychotic episode. Various maladaptive coping mechanisms emerged, and multiple data sources corresponded with the patient’s subjective reports. Discussion: Within an RDoC perspective, social sensorimotor, positive valence, and negative valence dysfunctions likely reflect primary deficits (rooted in adverse childhood experiences), whereas cognitive symptoms may relate to maladaptive coping mechanisms, although a primary link cannot be excluded.

Aleš Oblak, Matic Kuclar, Katja Horvat Golob, Alina Holnthaner, Urška Battelino, Borut Škodlar, Jurij Bon