Self-reflection and the brain: a theoretical review and meta-analysis of neuroimaging studies with implications for schizophrenia.

Several studies have investigated the neural correlates of self-reflection. In the paradigm most commonly used to address this concept, a subject is presented with trait adjectives or sentences and asked whether they describe him or her. Functional neuroimaging research has revealed a set of regions known as Cortical Midline Structures (CMS) appearing to be critically involved in self-reflection processes. Furthermore, it has been shown that patients suffering damage to the CMS, have difficulties in properly evaluating the problems they encounter and often overestimate their capacities and performance. Building on previous work, a meta-analysis of published fMRI and PET studies on self-reflection was conducted. The results showed that two areas within the medial prefrontal cortex (MPFC) are important in reflective processing, namely the ventral (v) and dorsal (d) MPFC. In this paper a model is proposed in which the vMPFC is responsible for tagging information relevant for 'self', whereas the dMPFC is responsible for evaluation and decision-making processes in self- and other-referential processing. Finally, implications of the model for schizophrenia and lack of insight are noted. (c) 2009 Elsevier Ltd. All rights reserved.