Anomalous experiences and psychotic disorders: between diagnosis and culture

Abstract

Introduction: Anomalous experiences (AEs) refer to unusual subjective phenomena that are often confused with psychotic manifestations. However, when they do not involve significant distress or functional impairment, they may not be associated with pathological conditions. Objective: This study aims to analyze the criteria that differentiate AEs from psychotic disorders, considering clinical, subjective, and cultural aspects. Method: This is a narrative literature review, conducted according to the recommendations of SANRA conducted using PubMed/MEDLINE and SciELO databases, with complementary searches in Google Scholar, including studies published primarily between 2019 and 2024, selected based on clinical and theoretical relevance. Data were organized into thematic axes: clinical, subjective, cultural, neurobiological aspects, and assessment instruments. Discussion: Findings suggest that differential diagnosis involves, among other factors, preserved insight, absence of significant functional impairment, self-limited nature of the experiences, and compatibility with cultural context. Conversely, features such as persistence, thought disorganization, functional impairment, and presence of psychiatric comorbidities are associated with a higher likelihood of psychopathology. Neuroimaging studies indicate distinct patterns between non-clinical individuals with AEs and patients with psychotic disorders, while instruments such as the Community Assessment of Psychic Experiences (CAPE) and the Cardiff Anomalous Perceptions Scale (CAPS) may assist in assessment and screening. Conclusion: Altogether, these findings suggest that understanding AEs benefits from a multidimensional and culturally sensitive approach, with the potential to reduce both unnecessary medicalization and underdiagnosis of psychotic disorders, contributing to a more precise and humanized clinical practice.