Narrative identity in the psychosis spectrum: A systematic review and developmental model

Henry R. Cowan*, Vijay A. Mittal, Dan P. McAdams

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations


Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity—the study of internalized, evolving life stories—provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.

Original languageEnglish (US)
Article number102067
JournalClinical Psychology Review
StatePublished - Aug 2021


  • Life stories
  • Narrative identity
  • Psychosis
  • Schizophrenia
  • Self-disturbance

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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