A spontaneous dissociative episode during an EEG experiment.

A depersonalization episode occurred unexpectedly during an electroencephalogram (EEG) recording for a study. Experience reports tracked the time course of this event and, in conjunction, with EEG data, were analyzed. The source activity across canonical frequency bands was analyzed across four periods ended by retrospective experience reports (depersonalization was reported in the 2nd period). Delta and theta decreases occurred across all time periods with no relation to reported events. Theta and alpha increases occurred in right secondary visual areas following depersonalization, which also coincided with surges in beta and gamma. The largest increases occurred in bilateral fronto-polar and medial prefrontal cortex, followed by inferior left lateral fronto-insula-temporal cortices and right secondary visual cortex. A high frequency functional network with a principal hub in left insula closely overlapped inferior left cortical gamma band-power increases. Bilateral frontal increases in gamma are consistent with studies of dissociation. We interpret gamma and later beta, alpha, and theta band increases as arising from the generation of visual priors, in the absence of precise visual signals, which constrain interoceptive and proprioceptive predictions to reestablish a stable sense of physiological-self. Beta showed local increases following the pattern of gamma but showed no changes in functional connectivity.

The state-trait sense of self inventory: A psychometric study of self-experience and its relation to psychosis-like manifestations.

The sense of self is a fundamental construct in the study of the mind, yet its psychological nature remains elusive. We introduce a novel 25-item inventory to investigate selfhood both as an enduring trait and a temporary state. We hypothesized two foundational aspects of the self: identity (related to self-referencing and continuity over time) and agency (the perception of controlling own's actions and thoughts). Results from two population studies highlight a singular self-trait factor combining agency and identity. In contrast, self-state measures revealed a bifactorial structure with a high-order factor and three lower-order subfactors: state-identity, state-agency, and state-technology. These factors were predictive of psychosis-like experiences, schizotypal traits, and hopelessness. Mediation analysis demonstrated that the negative association between the sense of self and hopelessness is mediated by depressive manifestations. Our research provides a tool to shed new light on the complexity of the sense of self and its mental health implications.

Examining Identity Functioning in Anorexia Nervosa Across Illness and Recovery Stages.

OBJECTIVE: Research suggests that identity functioning (i.e., sense of self) issues may be a core feature of anorexia nervosa (AN). We aimed to investigate differences in identity functioning among women with AN at varying illness and recovery stages, and women with no history of eating disorders (non-ED controls). It was hypothesized that those with current AN (AN-C), weight-restored (AN-WR), and partial recovered individuals (AN-PR) would show poorer identity functioning than fully recovered individuals (AN-FR) and non-ED controls. METHOD: Women (334) with AN-C (n = 74), AN-WR (n = 90), AN-PR (n = 19), AN-FR (n = 22), and non-ED controls (n = 129) completed online self-report measures of identity functioning and ED symptom severity. RESULTS: The AN-C group showed significantly poorer overall identity functioning, poorer consolidated identity, and significantly worse disturbed and lack of identity, than the AN-PR, AN-FR, and non-ED Control groups. The AN-WR group showed significantly poorer overall identity function, and worse lack of identity, than the AN-FR and non-ED Controls, and poorer consolidated identity and disturbed identity than non-ED Controls. Identity scores did not significantly differ between AN-PR, AN-FR, and non-ED Controls. DISCUSSION: Differences in identity functioning are identifiable among individuals at different AN recovery stages, and thus may represent an important state-based feature of AN, making it an important area of consideration in treatment.

Reclaiming Self-Balancing on a Tightrope Across Time a grounded theory of transition to survivorship in older adult blood cancer survivors.

AIM: To develop a theoretical understanding of the transition to survivorship in older adult blood cancer survivors. DESIGN: Qualitative research employing Classic Glaserian Grounded Theory methods. METHODS: Purposive and theoretical sampling recruited 17 participants via Leukaemia & Lymphoma Society© Community webpages (65-83 years) from across the US and Canada. Data from individual semi-structured interviews using HIPPA-compliant Zoom© were analysed from September 2020 to March 2021. RESULTS: Participants' main concern was losing their sense of self and reclaiming self was the core category. The substantive theory of Reclaiming Self-Balancing on a Tightrope Across Time is a six-phase transition process to survivorship: receiving a blood cancer diagnosis, finding bearings, reclaiming self, persevering through, realizing a transition and living in a new reality. CONCLUSIONS: The transition to survivorship in older adult blood cancer survivors is a complex process because of age and disease type. IMPLICATIONS: Age-related aspects of one's sense of self and its relation to health, well-being and quality of life, as older adult blood cancer survivors advance into older age need further research. Ageism and its impact on cancer survivorship care in older adults should also be explored. IMPACT: What problem did the study address?: Existing theoretical frameworks do not explain the complex process of transition to survivorship for older adult blood cancer survivors. What were the main findings?: A substantive theory Reclaiming Self-Balancing on a Tightrope Across Time is a six-phase transition process from cancer diagnosis to survivorship characterized by an uncertain and liminal nature. Where and on whom will the research have an impact?: Understanding how older adults experience the transition to survivorship can inform age-appropriate person-centered nursing practices and healthcare policies specific to their needs. REPORTING METHOD: COREQ. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Supporting Individuals With an Acquired Brain Injury: An Interpretative Phenomenological Study Exploring the Everyday Lives of Caregivers.

Acquired brain injury (ABI) is one of the most common causes of disability and death globally. Support from informal caregivers is critical to the well-being and quality of life of people with ABI and supports the sustainability of global health and social care systems. This study presents an in-depth qualitative analysis of the experiences of eight British informal caregivers supporting someone with ABI. Semi-structured interviews were conducted with narratives transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Three superordinate themes were generated: making sense of brain injury; being consumed by caregiving; and, the changing self. These data highlight the impact of caregiving on the caregiver's illness perceptions and sense of self. By identifying negative and positive changes in the caregiver's sense of self, and dilemmas regarding the care recipient's behaviour, we address less understood aspects of caregiver experiences. Caregiving can pose both challenges to the caregiver's sense of identity and an opportunity for self-growth. Some caregivers exhibit resilience throughout their journey, with post-traumatic growth more apparent in the later stages of caregiving. Illness perceptions shape caregiver well-being and family dynamics and indicate the need to address stigmatisation and discrimination faced by ABI survivors and caregivers. Although some caregivers acquired positive meaning and enrichment from their caregiving, previously described challenges of ABI caregiving are supported. Overall, our findings support the need for timely psychological/mental health support for caregivers, caregiver education, and the provision of short breaks from caregiving.

Neurophysiological explorations across the spectrum of psychosis, autism, and depression, during wakefulness and sleep: protocol of a prospective case-control transdiagnostic multimodal study (DEMETER).

BACKGROUND: Quantitative electroencephalography (EEG) analysis offers the opportunity to study high-level cognitive processes across psychiatric disorders. In particular, EEG microstates translate the temporal dynamics of neuronal networks throughout the brain. Their alteration may reflect transdiagnostic anomalies in neurophysiological functions that are impaired in mood, psychosis, and autism spectrum disorders, such as sensorimotor integration, speech, sleep, and sense of self. The main questions this study aims to answer are as follows: 1) Are EEG microstate anomalies associated with clinical and functional prognosis, both in resting conditions and during sleep, across psychiatric disorders? 2) Are EEG microstate anomalies associated with differences in sensorimotor integration, speech, sense of self, and sleep? 3) Can the dynamic of EEG microstates be modulated by a non-drug intervention such as light hypnosis? METHODS: This prospective cohort will include a population of adolescents and young adults, aged 15 to 30 years old, with ultra-high-risk of psychosis (UHR), first-episode psychosis (FEP), schizophrenia (SCZ), autism spectrum disorder (ASD), and major depressive disorder (MDD), as well as healthy controls (CTRL) (N = 21 × 6), who will be assessed at baseline and after one year of follow-up. Participants will undergo deep phenotyping based on psychopathology, neuropsychological assessments, 64-channel EEG recordings, and biological sampling at the two timepoints. At baseline, the EEG recording will also be coupled to a sensorimotor task and a recording of the characteristics of their speech (prosody and turn-taking), a one-night polysomnography, a self-reference effect task in virtual reality (only in UHR, FEP, and CTRL). An interventional ancillary study will involve only healthy controls, in order to assess whether light hypnosis can modify the EEG microstate architecture in a direction opposite to what is seen in disease. DISCUSSION: This transdiagnostic longitudinal case-control study will provide a multimodal neurophysiological assessment of clinical dimensions (sensorimotor integration, speech, sleep, and sense of self) that are disrupted across mood, psychosis, and autism spectrum disorders. It will further test the relevance of EEG microstates as dimensional functional biomarkers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT06045897.

Life satisfaction, generalized sense of self-efficacy and acceptance of illness in rheumatoid arthritis patients depending on age and severity of the disease.

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by periods of exacerbation (physical limitations, depressed mood, depressive states and decreased life satisfaction) and remission (hope of health improvement). Our objective was to present social functioning of RA patients taking into consideration their age and employing selected determinants: satisfaction with life, generalized sense of self-efficacy and acceptance of illness. Material and methods: Standardized tools were employed: the Satisfaction with Life Scale, Generalized Self Efficacy Scale and Acceptance of Illness Scale. The study group included 46 RA patients aged 18-45 years and 54 RA patients aged over 60 years. The control group consisted of 24 non-RA subjects in every group. Results: Rheumatoid arthritis patients in the period of disease exacerbation reported low and moderate levels of satisfaction with life, in the patients in remission period the score was moderate, while the control group subjects described their level of satisfaction with life as high and moderate. The level of acceptance of illness was described by the RA patients in the period of disease exacerbation as 20.4/40 points; the patients in remission defined their level of acceptance of illness as 29.38/40 points. The patients with RA exacerbation showed a low sense of self-efficacy, yet a large group of such patients also presented high self-efficacy levels and the majority of the RA subjects in remission reported a high sense of self-efficacy. Conclusions: In the RA patients, satisfaction with life, generalized sense of self-efficacy and acceptance of illness were closely related and affected their general psychosocial functioning.

I overthink-Therefore I am not: An active inference account of altered sense of self and agency in depersonalisation disorder.

This paper considers the phenomenology of depersonalisation disorder, in relation to predictive processing and its associated pathophysiology. To do this, we first establish a few mechanistic tenets of predictive processing that are necessary to talk about phenomenal transparency, mental action, and self as subject. We briefly review the important role of 'predicting precision' and how this affords mental action and the loss of phenomenal transparency. We then turn to sensory attenuation and the phenomenal consequences of (pathophysiological) failures to attenuate or modulate sensory precision. We then consider this failure in the context of depersonalisation disorder. The key idea here is that depersonalisation disorder reflects the remarkable capacity to explain perceptual engagement with the world via the hypothesis that "I am an embodied perceiver, but I am not in control of my perception". We suggest that individuals with depersonalisation may believe that 'another agent' is controlling their thoughts, perceptions or actions, while maintaining full insight that the 'other agent' is 'me' (the self). Finally, we rehearse the predictions of this formal analysis, with a special focus on the psychophysical and physiological abnormalities that may underwrite the phenomenology of depersonalisation.

Relationships of self-awareness and facial affect recognition to social communication ability in persons with traumatic brain injury.

Traumatic brain injury (TBI) can cause changes to the injured person's physical ability, cognitive functioning, and social interactions. Since these attributes largely determine a person's concept of who they are, TBI poses a threat to sense of self. Due to the importance of social communication skills for community integration, impairment of these skills is a particular threat to sense of self. The present investigation sought to explore characteristics that influence social communication abilities. We hypothesized that both ability to interpret facial affect and self-awareness would be associated with communication ability. We also expected that facial affect recognition would influence self-awareness and that the effect of facial affect recognition on social communication would be partially mediated by self-awareness. For this prospective cohort study, participants were 77 individuals with documented TBI. Of these, 65% were male and 83% sustained severe injuries. The hypothesized association of facial affect recognition with social communication was demonstrated with path analysis as was the effect of facial affect recognition on self-awareness. However, the effect of facial affect recognition on social communication was not mediated by self-awareness. In addition, social communication was associated with employment, social integration, and loneliness. Findings highlighted the importance of social communication after TBI.

"I never thought I would be an international speaker but I am": an interpretive qualitative analysis of experiences of a project-based advocacy intervention.

Acquired brain injuries (ABI) result in changes to physical, cognitive, psychosocial, and economic domains, which alter an individual's sense of self and identity. Interactions with healthcare providers may further contribute to conceptualization of self after ABI. Cognitive rehabilitation is intended to address cognitive-communication impairments, as well as psychological changes to the sense of self and identity that follow ABI. The present investigation examined a project-based intervention, focused on advocacy. Participants developed a presentation for healthcare providers regarding consequences of ABI, strategies and supports necessary to successfully overcome daily challenges, and insights into the lived experience. Ten individuals with chronic ABI participated in one of three roles (presenter, video contributor, or content developer). Written interviews allowed participants to generate and refine their responses. Interpretive Description qualitative analyses was used to examine interviews. Iterative analysis identified five themes across all participant roles: renewed sense of self, positive impact on providers to care of future individuals with brain injuries, rewarding and humbling, being heard, and alternate personal narratives and identities. The remaining theme applied only to presenters, improved clarity and conciseness. Group, project-based interventions have the potential to positively influence sense of self in combination with narrative therapy techniques in the chronic phase of recovery.

Becoming anonymous: how strict COVID-19 isolation protocols impacted ICU patients.

In this article, I provide phenomenological reflections on patients' experiences of undergoing extreme isolation protocols while admitted to Intensive Care Units [ICU] during the first wave of COVID-19. Based on observation studies from within the patient isolation rooms and retrospective, in-depth phenomenological interviews with patients, I characterize this exceptional experience as one of becoming anonymous. To illustrate this, I start by establishing a perspective on embodied existence as constituted on a scale between anonymous embodiment and being enrooted into a personal niche. Against the backdrop of this framework, I illustrate how being admitted to the ICU under strict isolation protocols produced extraordinary experiences of becoming anonymous. Sources of the anonymization were: (1) Mechanical expropriation, pacification and disownership of the visceral-kinaesthetic body; (2) Objectification; (3) Spatial and intercorporeal anonymity (4) Surrealism: the intermingling of objective impressions and dream-like interpretations. Finally, I illustrate how anonymization induced an experience of embodiment as raw materiality, confronting the patient with what Martin Heidegger called the facticity of naked existence. This experience is discussed against Levinas' critique of Heidegger, while I propose that insights from this exceptional case may substantiate Heidegger's account.

Sense of self-efficacy and the content of energy and nutrients in the diet of elite Polish basketball players.

Background: In research on the subject, the predictive importance of personal resources is indicated for diet quality. Objective: The aim of the study was quantitative assessment of diet depending on the level of generalised self- efficacy among elite Polish basketball players. Material and Methods: Food diaries (2 training days and 1 no training day) of 48 basketball players were analysed. Further assessed were 144 food rations based on the Diet 6.0 program, and the results were compared to the current Polish nutritional standards. The Generalised Self-Efficacy Scale (GSES) was also used. Statistical analyses were performed by estimating Spearman's rank correlation coefficients (p<0.05). Results: The share of energy from proteins, fats and carbohydrates was 18.2%, 29.4% and 52.4%, respectively. Of the mineral salts, the average diet contained: 2,107.6 mg sodium, 2,918.3 mg potassium, 736.3 mg calcium, 1,372.2 mg phosphorus, 380.1 mg magnesium, and 11.6 mg iron. Of the vitamins, the average diet contained: 1,100.3 µg of vitamin A, 5.3 µg of vitamin D, vitamin E in the amount of 8.2 mg, 78.1 mg of vitamin C, 1.1 mg vitamin B1, 1.3 mg vitamin B2, 1.9 mg of vitamin B6, 271.7 µg of vitamin B9 and 4.7 µg of vitamin B12. It was also shown that as the sense of self-efficacy developed, the supply of energy, water, protein, digestible carbohydrates, energy from carbohydrates, sucrose and PUFAs also increased in the players' diets. At the same time, along with the increase in self-efficacy, the supply of: Na, K, Ca, Mg, P, Fe, Cu and iodine as well as vitamins: A, E, B1, B3, B6 and C, also increased in the players' diets. Conclusions: Incomplete diet balance has been demonstrated, as well as significant relationships between the level of self-efficacy and the supply of certain nutrients in the diet of elite Polish basketball players. The obtained results indicate the legitimacy of diet monitoring and nutritional education as well as considering personality traits in activities promoting maintaining a proper diet among athletes.

Professional Responsibility: Conceptual Rescue and Plea for Reform.

For as long as knowledge asymmetry continues to be deemed the defining characteristic of the lay-professional relationship, the courts' delineation of obligations meant to address lay vulnerability will too frequently end up compounding the layperson's non-epistemic, 'sense of self' vulnerability. The proposed re-conceptualisation of professional responsibility calls for reform on several fronts: among these, an expanded 'duty to consult' (beyond do-not-resuscitate-orders) is uniquely placed as a justiciable criterion capable of addressing such a situational, 'sense of self' vulnerability.

Listening to student voice-understanding student and faculty experience at two UK graduate entry programmes.

CONTEXT: Shortage of physicians in the UK has been a long-standing issue. Graduate entry medicine (GEM) may offer a second point of entry for potential doctors. However, the challenges of developing and implementing these programmes are still unrecognised. This small-scale study aimed to briefly explore the opportunities and challenges facing students at two UK GEM programmes. METHODS: Two case studies were conducted at Imperial College and Scotland's GEM (ScotGEM) and used a triangulated qualitative approach via semi-structured and elite interviews. Data analysis, informed by grounded theory, applied thematic and force-field analysis in an empirical approach to generate evidence and instrumental interpretations for Higher Education Institutions. RESULTS: Although GEM forms an opportunity for graduates to enter medicine, the different drivers of each programme were key in determining entry requirements and challenges experienced by postgraduates. Three key dilemmas seem to influence the experiences of learners in GEM programmes: (a) postgraduate identity and the everchanging sense-of-self; (b)self-directed and self-regulated learning skills, and (c) servicescape, management and marketing concepts. CONCLUSIONS: Graduate entry programmes may support policy makers and faculty to fill the workforce gap of healthcare professionals. However, their successful implementation requires careful considerations to the needs of graduates to harness their creativity, resilience and professional development as future healthcare workers.

Commercial Sexual Exploitation, Stigma, and Trauma: A Detrimental Trio for an Altered Sense of Self.

This study aimed to assess whether, and to what extent, the commercial sexual exploitation of female adolescents placed in residential care predicted different manifestations of an altered sense of self in emerging adulthood while considering the possible confounding effects of child maltreatment and perceived stigmatization. Data were gathered in a broader longitudinal study conducted among a sample of 124 female adolescents placed in residential youth care centers. Commercial sexual exploitation was self-reported during adolescence. Altered sense of self was self-reported in emerging adulthood with the following dependent variables: sense of failure, sense of defensiveness and shame, lack of self-awareness, and other-directedness. Findings suggest that, even after accounting for the significant effects of confounding variables, commercial sexual exploitation increases specific vulnerabilities pertaining to identity development. This creates unique intervention needs among young women. Our study adds to the literature by highlighting the unique influence of commercial sexual exploitation experiences among vulnerable female adolescents on their sense of self in young adulthood. Our results point to the relevance of considering the intersection of trauma and stigmatization when working with and providing services to adolescent females with a history of commercial sexual exploitation.

Selfhood triumvirate: From phenomenology to brain activity and back again.

Recently, a three-dimensional construct model for complex experiential Selfhood has been proposed (Fingelkurts, Fingelkurts, & Kallio-Tamminen, 2016b,c). According to this model, three specific subnets (or modules) of the brain self-referential network (SRN) are responsible for the manifestation of three aspects/features of the subjective sense of Selfhood. Follow up multiple studies established a tight relation between alterations in the functional integrity of the triad of SRN modules and related to them three aspects/features of the sense of self; however, the causality of this relation is yet to be shown. In this article we approached the question of causality by exploring functional integrity within the three SRN modules that are thought to underlie the three phenomenal components of Selfhood while these components were manipulated mentally by experienced meditators in a controlled and independent manner. Participants were requested, in a block-randomised manner, to mentally induce states representing either increased (up-regulation) or decreased (down-regulation) sense of (a) witnessing agency ("Self"), or (b) body representational-emotional agency ("Me"), or (c) reflective/narrative agency ("I"), while their brain activity was recorded by an electroencephalogram (EEG). This EEG-data was complemented by first-person phenomenological reports and standardised questionnaires which focused on subjective contents of three aspects of Selfhood. The results of the study strengthen the case for a direct causative relationship between three phenomenological aspects of Selfhood and related to them three modules of the brain SRN. Furthermore, the putative integrative model of the dynamic interrelations among three modules of the SRN has been proposed.

Recovering a sense of self in schizophrenia.

OBJECTIVE: Diverse theoretical orientations on psychopathology, including the most recent phenomenological and neuroscientific approaches, consistently have viewed a core component of schizophrenia to be the loss, or distortion, of a person's sense of self as an effective agent in a shared, social world. How such a sense of self becomes lost or distorted and the questions of whether or not, and if so, how it can be recovered have received considerably less attention. These questions are taken up in the present paper. METHOD: A review of a substantial body of longitudinal research, enhanced by a growing trove of recovery narratives, provides ample evidence that many people recover a sense of self over time. Based on a review of this qualitative literature, this contribution describes the components and processes involved in the gradual reconstruction of an effective sense of social agency. RESULTS: Processes of reconstructing a sense of self begin with acceptance and an instillation of hope, which together provide a foundation for rediscovering one's efficacy in seemingly small but concrete ways that then are incorporated into a sense of social identity as a worthwhile member of one's community. CONCLUSIONS: Implications of such an understanding for recovery-oriented practice are considered.

Self and identity in social anxiety disorder.

Models of social anxiety (SA) place the self as an organizing and causal center involved in the maintenance of this condition. An integrative conceptual framework for the understanding of the self is used to review the literature on the self in SA. Two main distinctions are emphasized: the self-as-a-subject (I-self) versus self-as-an-object (Me-self), and the evolutionary-based distinction of social rank versus affiliation. We argue that (a) although much progress has been made in understanding the association between SA and Me-self, the association between SA and I-self remains largely unexplored (with the important exception of anxiety-related processes in social situations); and (b) experiences and representations of the self in SA center on social rank. We suggest that in SA, social rank themes constitute the linchpins of identity, defined as the content and structure of the Me-self. We speculate that processes related to low social rank contribute to the focus on representational (Me), rather than experiential (I), self-aspects. Finally, we delineate the ways in which such an understanding may direct and refine the construction of novel, individually tailored, therapeutic approaches.

The behavioral presentation of an individual with a disordered sense of self.

There is increased recognition that the brain processes a "sense of self" (best understood as a sense of "mineness") in the right hemisphere association area and which can be distorted due to neurologic injury. Although there are numerous descriptions of types of disorders of the self (e.g., asomatognosia, anosognosia, mirror misidentification disorder, Capgras syndrome, schizophrenia), there are few descriptions of the subjective experiences of individuals with traumatic brain injury (TBI) who experience a reduced sense of self. This article presents a longitudinal case study of a woman in her early 40s with a primarily right hemisphere TBI and disorder of the self who had difficulties relating her experiences from the perspective of the self. Subjective interviews, neuropsychological test scores, and objective personality testing illustrate how she reported her experiences of a diminished sense of self, and how this sense of self improved over the normal course of recovery following the TBI. This case demonstrates clinically relevant information regarding how individuals with a reduced "sense of self" (i.e., "mineness") associated with a right hemisphere TBI may report their subjective experiences and perform on objective testing.

A qualitative investigation of sense of self and continuity in younger adults with stroke.

Younger adults are more likely to survive after stroke and their life trajectory is often disrupted. This qualitative study aimed to explore the experience of sense of self and continuity in younger adults after stroke. In-depth semi-structured interviews were conducted with 10 adults (3 male, 7 female) with stroke onset between 18 and 55 years of age. Their interview transcripts were analysed using a phenomenological approach that involved idiographic and nomothetic stages of analysis. Two major themes emerged: (1) centrality of stroke; and (2) impacts of stroke on self. The first theme relates to how central the stroke is in participants' lives. The second theme depicts ways in which stroke influences participants' sense of self. In general, participants who perceived their stroke as having lower centrality also experienced continuity of self, whereas participants who viewed their stroke as higher in centrality experienced interruption of self which often co-existed with growth of self. However, perceptions of stroke centrality and the impacts on self shifted over time and context. These findings extend conceptualisations of post-stroke adjustment by indicating that the impact of stroke on sense of self during early to middle adulthood is linked to how central people perceive their stroke to be within their life story. Younger adults may simultaneously experience their sense of self as continuous, interrupted, and grown after stroke.