The study addresses the challenges posed by psychiatric comorbidity and the limitations of categorical diagnostic systems like DSM and ICD. These systems are criticized for their reliance on symptom clusters, overlooking individual heterogeneity and the complex interplay of symptoms. The authors advocate for a dimensional view and a deeper understanding of patients' lived experiences, proposing personalized network models (PNMs) as a valuable tool. PNMs represent a person's lifeworld as a network of interconnected nodes (variables) and edges (relationships). The study aims to demonstrate the integration of PNMs into qualitative phenomenological methodology, evaluate the usefulness of PNMs and RDoC in psychiatric diagnosis, and introduce a novel phenomenological category: "crisis of objectivity". The case study approach is justified by the need to refine the PNM framework and address complex cases where multiple symptom constellations exist, mirroring the approach of phenomenological psychopathology.

The paper reviews existing critiques of traditional diagnostic systems, emphasizing the limitations of categorical classifications and the prevalence of comorbidity. It discusses the Research Domain Criteria (RDoC) framework as an attempt to move towards a dimensional understanding of mental disorders, focusing on endophenotypes and explanatory pluralism. However, the authors acknowledge the criticisms of dimensional models from a phenomenological perspective. The authors then introduce the concept of maladaptive sensemaking as a central feature of psychiatric disorders and propose PNMs as a methodology to study this. They mention previous studies using PNMs but also address the critiques of this approach, particularly regarding boundary problems and perspectivism. The paper highlights the need for a refined PNM approach grounded in contemporary qualitative phenomenology.

The study followed Hernan for 18 months, collecting data through 19 interviews. These included in-depth phenomenological interviews using micro-phenomenology, interpretative phenomenological analysis, and constructivist grounded theory. Semi-structured interviews (Examination of Anomalous Self Experience – EASE; Examination of Anomalous World Experience – EAWE) were also employed to assess specific symptoms. Additionally, a modified mini-RDoC battery was used to evaluate Hernan across various psychological domains (positive affect, negative affect, social cognition, sensorimotor cognition, hot cognition, and cold cognition). Qualitative data analysis involved inductive-deductive coding and the construction of a PNM. The PNM depicts salient aspects of Hernan's life as nodes, with connections representing upregulation or downregulation between them. The researchers also conducted keyword analysis, comparing the frequency of epistemological terms in Hernan's interviews to those in two previous studies (one with a normative population, and one with a transdiagnostic sample of altered realness experiences). Quantitative symptom measures included the Schizotypal Personality Questionnaire (SPQ-32), Yale-Brown Obsessive Compulsiveness Scale (Y-BOCS), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Assessment (GAD-7), Symptom Checklist (SCL-90), WHO Disability Assessment Schedule (WHODAS 2.0), Rumination Response Scale (RRS), and Childhood Trauma Screener (CTS).

Hernan's clinical scales revealed mild OCS, moderate depressive symptoms, and severe anxiety. His RDoC assessment showed mid-range scores for sensorimotor, negative valence, and positive valence systems but low scores in social processes and ambiguous scores in cognitive systems. Keyword analysis showed significantly higher use of epistemological terms (rationality, fact, objectivity) compared to normative samples. The core psychopathological theme identified through the PNM was "crisis of objectivity (COO)", reflecting Hernan's mistrust in his own cognition, stemming from childhood trauma and psychotic experiences. The PNM illustrated the interconnectedness of COO with other symptoms (psychotic symptoms, parasomnias, anxiety, OCS) and coping mechanisms (ruminative introspection). Ruminative introspection, a ritualized self-reflection process, was observed to downregulate anxiety and dissociation. Hernan's experience of dissociation, termed "Falling into the Sunken Place", was characterized by detachment from surroundings, perceptual anomalies, and a breakdown of lived time.

The findings suggest that Hernan's difficulties can be understood through the lens of a self-disorder, a disorder of sensemaking, and through the RDoC framework. The COO represents a disturbance in the "cognitive self", reflecting a mistrust in subpersonal processes. The study supports the clinical significance of the COO, connecting it to existing literature on doubt in OCS and the pervasive sense of doubt in obsessive-compulsive psychopathology. The RDoC perspective highlights potential dysfunctions in multiple domains, linking symptoms to disruptions in sensory integration, emotion recognition, and cognitive control. The study's multi-method approach allows for convergence of data, providing a richer understanding of symptom clusters and their underlying core theme.

This case study demonstrates the potential of integrating PNMs into qualitative phenomenological research to gain a deeper understanding of complex psychiatric presentations. The identification of "crisis of objectivity" as a central psychopathological theme offers a novel contribution to the field. Future research should focus on expanding the PNM framework to integrate quantitative data and explore the potential of this approach for personalized treatment. Further studies are needed to investigate the generalizability of the findings and the clinical utility of the COO as a diagnostic and therapeutic target.

The study is limited by its reliance on a single case study, potentially affecting generalizability. Although quantitative data was collected, it was not directly integrated into the PNM construction. Furthermore, the interviews were conducted remotely, potentially affecting the quality and validity of the data due to the lack of in-person interaction and intersubjective attunement. The absence of clinical tests (e.g., bloodwork and neuroimaging) limits the scope of biological factors that could be considered.