Category Archives: Bpd Articles

BPD And Algopsychalia

BPD And Algopsychalia

For several years, unremittingly, I was in a constant state of intense psychological torment. I realize this sounds melodramatic or exaggerated. It isn’t. In fact, no words can fully convey the intensity of the mental anguish from which I suffered.

I would complain to others I had a ‘terrible pain in my head’, neither physical nor solely mental, but some appalling, inarticulable, combination both. I constantly meditated on suicide as an escape : thinking about it, talking about it to anyone who would listen (other psychiatric inpatients when I was in hospital, cab drivers, even, once, when I was in a desperate state, sobbing, to complete strangers in a coffee bar – much to their alarm), planning it, researching how to do it online, buying various items to make it practicable (including, once, a rope with which to hang myself – a surprisingly complex purchase involving considerations of thickness, strength and length) and, more than once, attempting it. Indeed, the knowledge I could escape my pain by suicide was, ironically, the only reason I was able to endure it.

BPD And Algopsychalia

I told various psychiatrists about this, but, having experienced some psychiatrists to whom it was difficult to warm, I frequently felt paranoid in their presence and believed if I used terms like ‘psychological torment’ and ‘mental torture’ to describe my emotional state they’d regard me as an hysteric prone to exaggeration.

Instead, I used terms like ‘severe mental pain’ or ‘intense mental pain.’ Now, you’d think (would you not?) that that was putting it strongly enough to galvanize them into immediate and fervent therapeutic action. Stunningly, however, the usual response was a blank stare, a barely perceptible nod and a quick Biro jotting in their notebook (although I would not be surprised, in some cases, if they carried out this latter action because they were working on their shopping list at the time).

Another name for the mental anguish I describe is ALGOPSYCHALIA. This condition is particularly prevalent amongst people who suffer from borderline personality disorder (BPD).

Indeed, research shows that those with BPD are worse affected by algopsychalia than are people with any other personality disorder and/or mood disorder (including bipolar and unipolar depression).

This is, perhaps, why approximately 10% of those suffering from BPD end their lives by suicide and why many, many more BPD suffers unsuccessfully attempt suicide.

It also helps to explain why so many BPD sufferers seek to escape their pain through any means possible, such as overeating, chain-smoking, taking illegal drugs, gambling, compulsive sex and physical self-harm (to detract attention from mental pain and to release endorphins into the brain) amongst other forms of dissociation.

TREATMENT :

There is some research to suggest that several weeks of treatment with paracetomal my help alleviate certain aspects of this mental suffering (this is theorized to be the case because aspects of both physical and mental pain are processed by the same brain regions). Always consult a doctor when considering taking medications to treat BPD and other serious conditions.

Learning, and then regularly practicing, mindfulness has also been shown to be of therapeutic value.

Hypnosis can be utilized to alter the meaning we attribute to pain and, by doing so, alter our perception of it.

 

RESOURCES :

BPD And Algopsychalia Hypnosis for pain relief : click here.

 

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2017 Child Abuse, Trauma and Recovery

Symptoms Of Dissociation : Mild And Severe

Symptoms Of Dissociation : Mild And Severe

If we have suffered significant childhood trauma, we may, as adults, frequently find ourselves in various states of dissociation, ranging from mild to severe. Indeed, dissociation is a key feature of complex posttraumatic stress disorder (Cptsd).

What Is Meant By The Term ‘Dissociation’?

Dissociation is a symptom of the effects of childhood trauma which we developed as a defense mechanism in order to better equip us to cope with the emotionally painful and destructive environment in which we grew up. It is a way of mentally escaping and psychologically cutting off from reality; it is sometimes colloquially referred to as ‘zoning out’ or ‘tuning out’.

Dissociation And Flooding :

We are particularly likely to dissociate when we feel overwhelmed, or ‘flooded’, by stress and psychological threat. Symptoms of dissociation can range from mild to severe. I outline examples of such symptoms below:

Symptoms Of Dissociation : Mild And Severe

Mild symptoms include:

– feeling in a daze (sometimes referred to as ‘mind fog’),

– feeling utterly exhausted, numb and soporific for no obvious reason,

– finding oneself tongue-tied when trying to talk about difficult experiences (as if experiencing a kind of mental block).

 

More severe symptoms include:

– amnesia for certain events, or large periods of time, in one’s life (for example, I have no memory whatsoever of large chunks of my childhood) – such ‘dissociative amnesia’ far exceeds normal forgetfulness.

time loss : an individual may suddenly find him/herself in a particular place, with no memory of how s/he got there, unable to remember anything that has occurred in the recent past (eg the last few hours or days)

feeling very out of control (eg uncontrollably angry)

– periods of apparent deafness (at my first school, when things were at their worst at home between my parents, at times I did not respond to my name being called out in class – the school thought I was suffering from deafness; in fact, though, the cause was deep psychological trauma. This is certain as it became apparent this ‘deafness’ only occurred when the class was discussing parents/family matters or associated topics).

Symptoms Of Dissociation : Mild And Severe

 

Dissociation And Switching:

Some people dissociate when under extreme stress (ie when ‘flooded’, see above) in a way that almost resembles ‘changing personality’; this is referred to as ‘switching’.

In fact, it is NOT a literal switch of personality, but a switch of ego states/states of consciousness sometimes referred to by psychologists as ‘parts’ or ‘alters.’

Studies suggest that nearly all people who suffer such switching have experienced severe early life trauma. It is NOT a genetic disorder.

When a person switches due to stress, they switch from the ego state/state of consciousness/part/alter that s/he relies on for his/her day-to-day functioning to the ego state/state of consciousness/part/alter that is normally dissociated/’kept in a separate compartment’ in mind (it is this separation that allows the individual to function daily, by preventing the feelings in the dissociated part from interfering in it).

This dissociated part contains profoundly painful trauma related feelings such as fear, shame and anger.

 

Can dissociation be treated?

The short answer is, YES.

Individuals can be helped by becoming aware of the link between their childhood trauma and the dissociated part of their mind that they switch to when under severe stress.

As well as this, individuals suffering from dissociation can be enormously helped by learning the skills of mindfulness. Mindfulness, essentially, helps a person to live in the present/the ‘here and now’, rather than staying trapped in the past.

RESOURCES :

Excellent site about MINDFULNESS – mindfulness.org

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Symptoms Of Dissociation : Mild And Severe

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2017 Child Abuse, Trauma and Recovery

Questioning The Borderline Personality Disorder (BPD) Diagnosis

Questioning The Borderline Personality Disorder (BPD) Diagnosis

We have seen that if a person has suffered significant and protracted childhood trauma, s/he is at greatly increased risk of being diagnosed, as an adult, with borderline personality disorder (BPD). According to the Diagnostic and Statistical Manual of Mental Disorders (usually abbreviated to DSM), a person diagnosed with BPD must meet at least FIVE of the following nine criteria:

1) Extreme swings in emotions
2) Explosive anger
3) Intense fear of rejection/abandonment sometimes leading to frantic efforts to maintain a relationship
4) Impulsiveness
5) Self-harm
6) Unstable self-concept (not really knowing ‘who one is’)
7) Chronic feelings of ’emptiness’ (often leading to excessive drinking/eating etc ‘to fill the vacuum’)
8) Dissociation ( a feeling of being ‘disconnected from reality’)
9) Intense and highly volatile relationships

NB These symptoms must have been stable characteristics present for at least six months

Questioning The Borderline Personality Disorder (BPD) Diagnosis

However, some theorists and researchers have pointed out certain problems with defining BPD in this manner and question the validity of the diagnosis; I outline the most serious of these problems below :

1) In order to be diagnosed with BPD, a person need display just five of the above nine symptoms. It logically follows from this that two people could each be diagnosed with five of the above symptoms, yet have only one of those five symptoms in common with one another. In other words, two people could each be manifesting very different symptoms, yet receive identical diagnoses.

2) Stipulating that an individual must have five or more of the above symptoms is essentially arbitrary (why not four or six?). Also, linked to this criticism, there seems to be a third problem with the diagnosis :

3) The third problem is this : a person with four of the above symptoms, even if they were very severe, would have to be (according to the diagnostic criteria) diagnosed as NOT having BPD whereas a person who just manages to be judged to be displaying five symptoms (even if none are as severe as the first person’s four symptoms) WOULD be diagnosed as having BPD. This brings us onto the fourth problem with the diagnosis :

4) In accordance with the diagnostic criteria, an individual is either deemed to HAVE BPD or NOT HAVE BPD. In other words, it is an ‘all or nothing’ diagnosis which doesn’t allow for grey areas. This is ironic as one of the symptoms BPD sufferers are said to show is ‘black and white’ or ‘all or nothing thinking’ (such as seeing others as ‘all good’ or ‘all bad’ but never as anything inbetween).

Because of this problem, some critics have suggested that it would be better to view BPD as a ‘spectrum’ disorder, with each individual occupying a specific place on this spectrum (in the way that autism is treated as a spectrum disorder).

5) A diagnosis of BPD does not seem to describe a unique, separate, distinct disorder clearly delineated from other personality disorders ; indeed, many who have been diagnosed with BPD are found to suffer from comorbid conditions such as antisocial personality disorder and narcissistic disorder

In conclusion it should be mentioned that many critics of the BPD diagnosis feel many individuals have been wrongly diagnosed with it (and unnecessarily stigmatized) and should be diagnosed with complex post traumatic stress disorder instead.

In relation to the above, you may wish to read these other posts:

Other Resources :

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Questioning The Borderline Personality Disorder (BPD) DiagnosisQuestioning The Borderline Personality Disorder (BPD) Diagnosis

 

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2016 Child Abuse, Trauma and Recovery

Can Children Be Diagnosed With Borderline Personality Disorder (BPD)?

Can Children Be Diagnosed With Borderline Personality Disorder (BPD)?

Borderline personality disorder (BPD) is usually diagnosed in adulthood or late adolescence. But can children suffer from this serious psychiatric condition?

Unfortunately, there exists a paucity of academic research published on this particular topic, but some research and evidence relating to the question does exist, some of which I look at here.

Anecdotal Evidence Reported By Parents Of Adult Children With A BPD Diagnosis :

Whilst anecdotal evidence is not scientific, many scientific theories, hypotheses and research projects are preceded by, and have their foundations in, anecdotal evidence, so it shouldn’t automatically be contemptuously dismissed. So what is the anecdotal evidence that has been collected from parents?

Many parents with (now grown-up) children who have been diagnosed with borderline personality disorder (the adult children, not the parents) have reported that signs of BPD in their offspring started to show in early childhood and included the following :

  • particular proneness to worry
  • particular proneness to bouts of sadness
  • a greater than normal need for attention
  • hypersensitivity, especially in relation to criticism
  • proneness to becoming very easily frustrated
  • a susceptibility to developing physical symptoms in response to stress (called psychosomatic illness) such as headaches and stomach upsets
  • proneness to irritability, anger, rage and temper tantrums
  • easily upset

However, it is important to point out that not all parents of adult children diagnosed with BPD reported that these offspring had such childhood symptoms.

Can Children Be Diagnosed With Borderline Personality Disorder (BPD)?

Studies Related To The Question Of Whether Children Can Be Diagnosed With Borderline Personality Disorder (BPD).

In 1983, Cohen et al (Yale University) devised a set of diagnostic criteria for children suffering from what they called borderline syndrome; however, after further research they renamed the condition multiple complex developmental disorder (MCDD). This disorder incorporates three main categories of symptoms which are as follows :

  • poorly controlled (regulated) emotions
  • impaired perception and thinking
  • markedly disturbed relationships

NB The above symptom categories also occur in borderline personality disorder and complex post-traumatic stress disorder. (It should be noted, too, that MCDD has not been included in either DSM IV or ISD-10).


MCDD is also associated with anxiety conditions, psychotic thought processes and disruptive behaviour (de Bruin et al, 2007)

Physiological Basis :

Cohen also pointed out that many of these children were found to have physiological brain disturbances and believed that there was a biological basis to MCDD. This adds further to the obvious argument that children affected in such a way are in crucial need of understanding, treatment and therapy – not judgment.

Vital Importance Of Early Detection And Treatment:

Whilst it may well be stigmatizing to be ‘labelled’ with borderline personality disorder (or similar condition), early detection of the disorder, or of symptoms displayed in those at risk of developing such conditions, is vital so that effective therapy may be started. The earlier detection and effective, sensitive, expert treatment begin, the better are likely to be the results of treatment (indeed, if left untreated, such conditions are likely to become more severe, entrenched and complex).

 

Finally, it must once again be reiterated that environmental factors / childhood trauma / childhood abuse are strongly linked to the development of BPD and similar conditions. In other words, a child with a genetic/biological predisposition that puts him/her at risk of developing BPD, or similar condition, may not do so if s/he grows up in a secure, loving stable family, whereas a child similarly genetically/biologically predisposed is at far greater risk of doing so.

 

Can Children Be Diagnosed With Borderline Personality Disorder (BPD)?   Can Children Be Diagnosed With Borderline Personality Disorder (BPD)?

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2016 Child Abuse, Trauma and Recovery

Often Craving High-Intensity / Highly Arousing Activities?

Often Craving High-Intensity / Highly Arousing Activities?

Those of us who suffered significant childhood trauma may, as adults, find it very hard to calm ourselves when experiencing stress and anxiety. This is sometimes referred to by psychologists as an inability to self-sooth or to regulate our emotions. The result can be that we find ourselves in chronic states of deep distress and intolerable emotional pain.

Such is the intensity of this pain that we might frequently find ourselves absolutely desperate to numb it. However, we may find, too, that the ‘ordinary’ ways mentally healthy individuals may use to calm themselves, such as talking to a friend, taking a relaxing bath, going for a walk or taking some other form of exercise are simply of very little, or no help. These activities can be categorized as low-arousal activities.

Instead, to reduce our mental anguish, we may be driven to seek out and undertake high-arousal activities, sometimes referred to as sensation seeking or thrill seeking.

Whilst such high-arousal activities may provide short-term relief, they tend, also, to cause us harm over the long-term and to be high-risk.

Often Craving High-Intensity / Highly Arousing Activities?

I provide examples of such high-arousal activities below :

Examples Of High-Arousal Activities :

  • getting very drunk
  • self-harming (eg cutting) . Whilst this causes physical pain it can simultaneously reduce psychological pain due to the biochemical effect it has on the brain. Also, physical pain can actually provide a welcome distraction from comparatively far more distressing mental pain.
  • abusing drugs
  • high-stakes gambling (read about my experience of this here).
  • excessive, promiscuous sex (possibly leading to feelings of self-disgust)
  • anti-social behaviours such as stealing cars, joy-riding, shop-lifting
  • planning suicide (not only can this produce a high level of mental arousal but can also provide one with a sense of control. Indeed, at one period in my life, which I have written about elsewhere, I contemplated suicide virtually all day and every day for a period of several months; the only way I could fall asleep at night, in fact, was by repeatedly reminding myself that it was within my power to end my suffering. Paradoxically, it was this thought that kept me alive, however odd that might sound.

The high arousal activities that I have listed above are sometimes referred to as ‘acting-out’ behaviours which you can read more about by clicking here.

NB Seeking out high risk, intensely arousing activities can be a major component of borderline personality disorder (BPD). At present, one of the most effective available treatments for this condition is dialectical behaviour therapy (DBT).

 

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Often Craving High-Intensity / Highly Arousing Activities?

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OTHER RESOURCES :

Often Craving High-Intensity / Highly Arousing Activities?IMPROVE IMPULSE CONTROL.

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Copyright 2016 Child Abuse, Trauma and Recovery

Early Trauma’s Effect On Development Of Id And Ego

 

Early Trauma's Effect On Development Of Id And Ego

According to psychodynamic theory, originally associated with Sigmund Freud (but modernized by various psychologists since), the most crucial part of our psychological development takes place in the earliest years of our lives, between birth and about five years old (this is why very early trauma is especially damaging). A central concept of psychodynamic theory is that our minds comprise three parts, namely the id,  the ego and the superego, which I briefly describe below:

THE ID : According to Freud, the id can be viewed as the primitive part of the mind, driven by biological needs (such as for food and sex), which demand instant gratification ; it is completely unsocialized and its operations are unconscious. It is also described as acting according to the ‘pleasure principle‘ which means it is constantly and potently urging us to gain pleasure, irrespective of consequences (including harmful effects on others and harmful effects on ourselves).

THE SUPEREGO : Basically, the superego represents our conscience which we form by internalizing a sense of ‘right’ and ‘wrong’ (or morality) derived from the influence of our parents, education, social environment and culture. Freud stated that whilst some of the operation of the superego is conscious, much of it also occurs on an unconscious level. Our ‘punishment’ for transgressing the superego’s exacting moral standards is guilt.

THE EGO : Freud said that whilst the id operates according to the ‘pleasure principle’, the ego operates according to the ‘reality principle’. Essentially, its task is to mediate between the deeply conflicting demands of the id, the superego and the outside world (and it is this constant need to mediate and reach an unending series of compromises that contributes much to the inner turmoil, tension and anxiety being human must necessarily entail, Freud helpfully informs us). It acts according to reason and will try to inhibit impulses that, if acted upon, would lead to harm; in other words, it takes into account the possible consequences of our actions.

I remember, as a first year psychology undergraduate, our lecturer telling us that the ego’s job could, perhaps not wholly inaccurately, be compared to that of a referee who finds himself constantly obliged to oversee a fight between a ‘crazed chimpanzee’ and ‘a puritanical, pious and forbidding grandmother.’

Early Trauma's Effect On Development Of Id And Ego

 

Above : The perpetual battle between the id and superego, with the ego always having to act mediator.

It is theorized that if the infant is traumatized in early life, through lack of adequate care, s/he will fail to learn to control his/her basic drives and impulses and the development of his/her ego will be impaired. This can lead to various problems including :

  • poor ability to tolerate frustration
  • poor ability to inhibit impulses that may lead to harm (too likely to act in accordance with the dictates of the id due to deficits in ego development)
  • lack of consideration concerning the possible effects of one’s actions upon others / not taking into account the needs of others (including, as an infant, impaired ability to pick up on verbal and visual cues of the mother / primary care-giver)
  • impaired judgment
  • impaired ability to think logically and with clarity

It is thought that these problems occur as inadequate care that traumatizes the infant can damage the actual physical development of certain vital brain regions.

The infant who experiences satisfactory care, attention and nurturing, on the other hand, will learn to better control his drives and impulses, having learned from the mother to keep him/herself relatively calm and not exhibit unwarranted distress if his/her biological needs happen to not be instantaneously met (this ability is known as the competence to ‘self-regulate’).

Many of the symptoms of borderline personality disorder (BPD), which is linked to childhood trauma, reflect some the symptoms listed above.

 

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OTHER RESOURCES :

Early Trauma's Effect On Development Of Id And EgoIMPROVE IMPULSE CONTROL

 

Early Trauma's Effect On Development Of Id And EgoCONTROL YOUR EMOTIONS

 

 

David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Symptoms Of BPD Require Early Intervention

Symptoms Of BPD Require Early Intervention

It is problematic trying to diagnose borderline personality disorder (BPD) in children as their personalities are still developing. However, some children exhibit symptoms which seem to mimic the symptoms of BPD.

Ideally, BPD would be prevented before it fully develops so identifying symptoms which suggest BPD may develop later on in an individual’s life as early as possible is clearly desirable in order to start appropriate therapy before the problem becomes out of hand.

Early treatment is particularly valuable as the young child’s brain is at its most ‘plastic’ which means, by using the appropriate therapies, its physical development can be much more easily beneficially altered than would be the case in adulthood.

Also, the earlier therapy is given, the less time undesirable symptoms have to ‘take root’ and become ingrained into the young person’s behavioural patterns.

Symptoms Of BPD Require Early Intervention

One therapy that may be used for therapeutic purposes in connection with the above is known as floor time therapy‘ (also referred to as the Developmental – Individual difference – Realtionship-based Model or DIRand was originally developed by Greenspan (1989).

Although the therapy was originally developed in order to treat children with autism, it can be used to treat a variety of childhood psychological conditions, including the treatment childhood symptoms similar to those of BPD such as dramatic shifts in mood and difficulty controlling impulses. (However, further research is needed to establish, more accurately, this therapy’s effectiveness).

It is called floor time therapy for the very simple reason that it involves the parent getting on the floor with the child and playing (in a specialized way taught by the therapist) with him/her.

Therapists trained in this type of therapy include some specialized psychologists and occupational therapists.

Finally, it should be noted that many children who might benefit from such therapies miss out as they are regarded as ‘difficult’, ‘troublesome’, ‘over-sensitive’ etc when, in fact, there may be a strong biological component underlying their behaviour over which the child has no control ; blaming such a child then severely compounds the problem.

RESOURCES :

You can visit Dr Greenspan’s site about this therapy by clicking here.

 

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Copyright 2016 Child Abuse, Trauma and Recovery

BPD Sufferers May Have Subtle Learning Difficulties

BPD Sufferers May Have Subtle Learning Difficulties

Research suggests that individuals who suffer from borderline personality disorder (BPD) may have mild to moderate dysfunctions in certain areas of cognitive processing, in particular in the area of learning and memory that involves the processing of complex information.

However, such problems tend to be subtle and are therefore difficult for doctors, psychiatrists, psychologists and other clinicians to detect.

Notwithstanding this difficulty of detection, brain abnormalities have shown up in EEGs of borderline personality disorder (BPD) sufferers that are consistent with the learning/memory problem hypothesis.

In particular, the difficulties in cognitive processing appear to be associated with both visual and verbal memory (including, it is currently thought, both the encoding and retrieval of information) in which complex information is involved.

Borderline Personality Disorder (BPD) Sufferers Frequently Seem Incapable Of Learning From Experience – Is This Why?

These findings have given rise to the hypothesis that these subtle problems relating to learning and memory may help to explain why those suffering from borderline personality disorder (BPD) so frequently seem to make the same mistakes over and over again, seemingly incapable of learning from their social and interpersonal experiences.

Why May These Subtle Memory And Learning Problems Exist In Borderline Personality Disotder (BPD) Sufferers?

Many people who suffer from borderline personality disorder (BPD) experience periods of dissociation ( you can read about my article on dissociation by clicking here), particularly when under severe stress, and this state is clearly likely to seriously impair their memory functioning and, it follows, their ability to learn.

Also, the majority of individuals who go on to develop borderline personality disorder (BPD) as adults have suffered significant childhood trauma due to abusive parenting and it is known that this can lead to damage being done to the vulnerable, highly plastic, developing physical brain (to read my article about how childhood trauma can damage the developing brain on an organic level click here).

Further, severe clinical depression frequently co-morbidly exists alongside borderline personality disorder (BPD) which itself can impair both memory and learning.

Finally, it should be noted that research into this area is still at an early stage so more research needs to be conducted in order to confirm or shred further light upon the above theories.

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BPD Sufferers May Have Subtle Learning Difficulties

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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