A Qualitative Study on Identity in Individuals at Clinical High Risk for Psychosis: " horizontal ellipsis Why Does It Have to Be One Thing?"

Objective: Qualitative research can shed light on the subjective experiences of individuals at clinical high risk (CHR) for psychosis, complement quantitative research, broaden our understanding of experiencing CHR, and inform intervention development. The aim of this study was to explore life experiences of individuals at CHR through qualitative research. Method: Participants were 37 individuals at CHR (20 male, 17 female) aged 16-34 (M (age) = 23.32 +/- 5.26), and 16 healthy controls (HCs; 7 male, 9 female) aged 18-34 (M (age) = 25.37 +/- 4.05). Qualitative data were obtained through open-ended interviews (30-45 min). No a priori hypotheses were made, and thematic analyses were used to develop themes. Results: Four major themes and one subtheme related to identity were identified through the iterative thematic analysis: defining a self-concept (with a subtheme of creativity), identity development/formation, feeling different from others, and change from a former self. Over 80% of the CHR cohort spontaneously discussed topics related to their identity, compared to 38% of HCs. HCs only reported content within the defining a self-concept theme, while the CHR group reported content within all themes. Conclusions and Implications for Practice: The present study demonstrates that identity formation is a major process for youth in general and that psychosis experiences can make this process more challenging. CHR participants spontaneously brought up multiple themes related to identity in open-ended interviews, suggesting the relevance of this topic in this population. Clinicians should continue to probe identity-related concerns on an individual basis and research should focus on integrating this framework into the conceptualization and treatment of CHR. Impact and Implications This qualitative study demonstrates that identity formation is a major process for youth and psychosis experiences can make this process more challenging. Individuals at clinical high risk (CHR) for psychosis spontaneously brought up multiple themes related to their identity, suggesting the relevance of this topic. Clinicians should continue to probe identity-related concerns on an individual basis and research should focus on integrating this framework into the conceptualization and treatment of CHR.